From delaying the employer mandate to postponing the verification requirements for receiving subsidies in the Affordable Care Act’s health care exchanges, the national news surrounding the administration’s ongoing effort to implement President Obama’s signature health care law has become a slow drip of disheartening projections. But during a background briefing with reporters on Friday, senior White House officials insisted that they are meeting their implementation milestones, while only postponing those provisions of the law that require more time for businesses and others to implement properly.
The administration does not see the implementation process as a mammoth undertaking that will affect 17 percent of the economy, 260 million insured Americans and the 48 million uninsured. And it brushes aside suggestions that Americans have become too disillusioned with government and frustrated with Obamacare to sign up for coverage. To the White House, implementation is a micro-local effort that will engage engage mayors, local officials, community leaders, and family members to target and enroll a very specific group of Americans in health insurance.
Officials believe that the population that will make the law work won’t be swayed by the latest Washington chatter or House efforts at repeal. Of the seven million people that the Congressional Budget Office projects will sign up for insurance in the health care exchanges between October and March, approximately 2.7 million need to be young people for the marketplaces to function properly. These are African American and Hispanic men between the ages of 18 and 35 living in urban America, who are concentrated in three states: California, Florida, and Texas and they presently want, but cannot afford, to purchase coverage.
Multiple states have begun public enrollment campaigns to encourage the target young demographic to enroll in coverage and the federal government and its industry partners — including health insurance companies — will follow suit. Expect to see a rash of advertisements as enrollment begins on October 1, with specific ads designed to appeal to the desirable age group. Ads will pop-up in Cosmo and other women’s magazines, online, and on TV channels with strong male audiences like BET, MTV, G4, and Spike. As individuals visit the online portals — either because they are uninsured and want to purchase coverage or are merely curious about “Obamacare” — officials expect that they will tune out the political noise and become engaged in a deeply personal consumer experience.
Individuals will be able to fill out a 3-page application in less than about 10 minutes and will be told if they are eligible for Medicaid, the cost of coverage in the exchange marketplaces and if they qualify for government subsidies. In the approximately 21 states where Medicaid has not been expanded, officials are working on language that will inform the user that a governor’s or legislature’s decision prevented them from receiving lower-cost insurance.
The prices young people see should be affordable, officials contend, as estimates show that most will be eligible for tax credits. The Congressional Budget Office projected in May that out of the seven million who will enroll in the exchanges in 2014, six million will qualify for subsidies. Census data similarly projects that 54 percent of individuals between the ages of 18 and 35 in California and 45 percent of young Floridians will receive tax credits and won’t experience prohibitively high rates.
The senior administration officials are optimistic that this kind of precise, locally based campaign will successfully enroll the proper ratio of healthy young people to older sicker people to ensure that coverage is affordable. But they also believe that the enemies of Obamacare may be its best friends, as the hyperbole surrounding the law has lowered expectations so much for so many people, that when they don’t see the death panel and instead find subsidized coverage for their pre-existing conditions, they will shed their inhibitions to reform.