Obamacare Continues to Be a Tough Sell

Administration fights uphill battle in implementing health reform law.

In what turned out to be unfortunate timing for the White House, President Obama traveled to San Jose, California, this month to tout his health care law and kick off a summer push to get Americans ready to sign up for insurance under new online marketplaces, scheduled to open on Oct. 1.

But the health care law wasn't the news of the day. A massive government surveillance program had just been revealed in the press and provoked a loud public outcry. The one question Obama took after his San Jose speech was about the NSA's surveillance program, not the 2010 health reform law that's facing a make-or-break test less than four months away.

The president's off-message moment in San Jose is illustrative of the endless challenges the administration faces in trying to sell the health care plan to voters and sign up the uninsured through exchanges, websites intended to be one-stop shopping for health insurance. The administration faces myriad challenges in preparing people to make complicated health insurance decisions using an unfamiliar interface come October. And so pro-Obamacare groups are preparing to launch a multi-million dollar public relations blitz this summer reaching out to communities, educating consumers and training workers to assist people in enrolling.

Making the sell for Obamacare will be a particularly tough challenge for the national organizations. States are all approaching the exchanges differently; some are working in partnership with the federal government, some are going it alone and others are letting the federal government run the show. Not all states are expanding their Medicaid programs, which will leave certain low-income adults without any affordable health insurance options. Different groups have different concerns about the law, and different insurance needs. The Obama administration may be well positioned to find and target these groups – micro-targeting is something it was renowned for during the latest presidential campaign – but getting people to sign up for insurance could prove much more complicated than getting out the vote.

The Government Accountability Office released a report on Wednesday raising questions about the exchanges' readiness for enrollment by the October deadline. "Whether these efforts will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined," the report said.

Health policy experts say the June push is an attempt to hit the sweet spot of getting consumers up to speed before the exchanges open, but even some supporters worry that the groundwork should have been laid long ago.

Organizing for Action, a nonprofit dedicated to selling the administration's agenda, plans to spend seven figures this summer on a series of ads touting the law and released the first this week. Enroll America, a nonprofit dedicated to getting people to sign up for insurance under the new law, kicked off its "Get Covered America" campaign this week and expects to spend "in the tens of millions of dollars," according to president Anne Filipic, on outreach efforts over the course of the campaign.

Such efforts will be crucial to the success of the contentious law. The effectiveness of the exchanges depend on lots of people signing up. The administration needs young, healthy patients to enroll so it will drive down costs for everyone else. The challenge: They are also among the most difficult to convince to enroll.

Pro-Obamacare groups did get some good news this week in the form of the Kaiser Family Foundation's latest health tracking poll. According to the poll, more than seven out of ten adults under age 30 consider having health insurance to be personally important. That's a sign the administration has some opportunities to convince young adults to sign up.

Enroll America's Filipic, who also worked on the Obama campaign, told National Journal that the group was researching which messages resonate with which groups; financial security, for example, strikes a chord with young people, they found. "Really, how we're thinking about this effort is taking some of the best practices from past enrollment efforts, so from - whether it's CHIP [Children's Health Insurance Program] or Medicare Part D or Massachusetts – taking those lessons learned and those best practices, and then adding to that some of the really innovative work that's been done in recent years by the private sector, by corporate marketing campaigns, by electoral campaigns, by other organizations," she said.

But Keith Nahigian, who helped design the Medicare Part D prescription drug enrollment campaign during the Bush administration, thinks the White House and other pro-Obamacare groups are starting this push far too late. During Medicare Part D, he said, not only did public outreach begin much earlier, but they also had support from state and local government officials. That won't be the case to the same extent for Obama's controversial health reform law, which the House has voted to repeal 37 times.

"If you don't build partnerships, and you don't have third-party validators and local trusted sources, you only have one-way communication of government telling people to take a personal health care decision, and right now there's not a lot of trust of people and government, and also there's a cost," Nahigian said, referring to the fact that unlike voting for a candidate, individuals will be paying for insurance under the new law.

Because funding for outreach efforts is limited, the administration and other pro-Obamacare groups are relying on private organizations, like Planned Parenthood and Doctors for America, which are partnering with Enroll America this summer, for help.

"We are going to be ready. We are on schedule," said Gary Cohen, director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services, in a Thursday conference call with reporters. "Things are proceeding well with all the aspects of what we need to do to create the marketplaces in all the states, and so that's really all I have to say about that."