Can the White House sell America on health care exchanges?

Liz Goodwin
Senior National Affairs Reporter
Yahoo News
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On Tuesday, the race to enroll Americans in the health insurance marketplaces established by President Barack Obama’s 2010 health care law begins — and it appears the Obama administration has a steep hill to climb to explain what exactly the exchanges are.

One recent poll shows that nearly half of Americans have never even heard of the exchanges, even though millions of young and healthy people must enroll in them for Obamacare to work. And much of the outreach by the White House and allied groups on the issue has just started in the past few weeks, despite three and a half years of criticism that Obama has not adequately sold the country on his signature piece of legislation.

Meanwhile, conservative groups have poured millions of dollars into advertising and other campaigns to discourage people — especially young people — from buying the insurance, in the hopes Obamacare will fail.

The president and his team have emphasized the insurance will be so affordable that Americans will decide for themselves to buy it, despite the messages they’re being bombarded with from the opposing side. The White House has poured its time and energy into building and promoting a central website where people who live in the 36 states where the federal government manages part or all of the exchanges can purchase insurance and see if they qualify for tax breaks.

The president is essentially taking an “if you build it, they will come” stance.

[Read our explainer on the health insurance exchanges]

“There has been billions of dollars spent making people scared and worried about this stuff,” Obama said this week in a discussion with former President Bill Clinton in New York. “And rather than trying to disabuse people of every single bit of misinformation that’s been out there, what we’re saying is just look for yourself. Take a look at it and you will discover that this is a good deal for you.”

Analysts at Credit Suisse released a report this week, flagged by NPR, that seemed to support the president’s claim. The report found that approximately 6.5 million Americans who are currently uninsured will have access to a health care plan that costs zero dollars, when you include federal tax breaks.

“Given our analysis, we simply do not believe that affordability will be the roadblock” to enrolling 7 million people on the exchanges in 2014, the report concluded. (Seven million is the number of people estimated by the Congressional Budget Office to sign up on the exchanges in 2014.)

But the analysts pointed out that “the general lack of information and understanding around exchanges” as well as “the limited communication and outreach to this point” could become factors that lead to lackluster enrollment.

The Obama administration, for its part, insists that its late outreach push has made sense, saying it didn't make sense to raise awareness of the exchanges before people could actually buy the insurance.

“It’s not six days, it’s not six weeks, it’s a six-month period that is both a matter of raising awareness as well as taking people through the consumer continuum,” said David Simas, senior adviser for communications and strategy at the White House. “When you first engage, you need to engage at the time when people can act on your call to action. If you begin this massive outreach campaign in July, well that’s great, but [the consumer] can’t do anything about it.”

Starting in October, the administration wants to make sure people are getting “hit with similar messages once a day or a couple times a week” from radio ads, TV ads, social media and other sources. These messages will vary widely by state and even by county.

Oregon, Nevada and Maryland — which set up their own health insurance exchanges — began aggressive outreach campaigns over the summer according to a report from the nonprofit Kaiser Family Foundation. Oregon alone plans to spend $17 million in outreach and marketing, including a whimsical ad campaign featuring a hipster-like Oregonian floating around under the slogan “Long live Oregonians.” 

Other states, meanwhile, are spending far less on outreach, raising the possibility of a significant participation imbalance among states. For example, Florida Gov. Rick Scott has banned people trained in enrolling people on the exchanges, called "navigators," from county health departments, citing privacy concerns.

The Obama administration, meanwhile, has encouraged outside groups like Funny or Die, an online video site with a younger audience, and various celebrities to create their own awareness campaigns and encourage their fans to buy insurance.

Simas said the administration will be analyzing enrollment data over the six-month period so they can adjust their outreach strategy if they see that one tack is working better than another.

Potential bugs and glitches in the system could also scare people off from enrolling. The Wall Street Journal has reported that the software on the government’s health exchange website has a bug that makes it incorrectly calculate how much each plan costs. The administration says these bugs will be fixed by Tuesday. Meanwhile, the White House announced it was delaying the part of the website that would have allowed small businesses to shop for insurance because of glitches.

But at the end of the day, Simas, like the president, is hoping that the prices speak for themselves.

“When you ask people who don’t have insurance why they don’t have insurance, the overwhelming majority of them say they can’t afford it,” he said.