Part of the problem, experts say, is that people who will be affected don’t realize the urgency because the subsidies won’t begin for another year. But policy decisions are being made now that will affect tens of millions of Americans, and the lack of public awareness could jeopardize a system that depends on having many people involved. Low enrollment could lead to higher premiums, health policy experts say. Hospitals worry that, without widespread participation, they will continue getting stuck with patients’ unpaid medical bills. And advocates say the major purpose of the Affordable Care Act – extending health insurance to more Americans – will go unmet if large numbers of vulnerable people don’t take advantage of it.
But because “Obamacare” has been so controversial, and its fate caught up in the presidential campaign, there has been little public discussion about the specifics of putting it into action. States such as Texas and Florida, where opposition to the legislation was strong, have been slow to embrace the law and critics have been loath to promote it.
Initial White House efforts at outreach caused congressional Republicans to accuse the administration of using taxpayer money for political gain. In mid-November, Ways and Means Committee Chairman Dave Camp (R-Mich.) subpoenaed Health and Human Services Secretary Kathleen Sebelius, demanding information about how her agency has used federal money to promote the Affordable Care Act. The administration is preparing a final budget for an outreach program focused on the opening of the exchanges in October.
Even as Congress was finishing the debate that led to the law, a coalition of health-care advocates formed to help promote it. Led by Families USA co-founder Ron Pollack, the group started Enroll America, a nonprofit largely funded by health-care industry and philanthropy groups.
In the coming months, the group will begin an advertising campaign meant to encourage Americans to sign up for the health-care law’s subsidized insurance coverage. Still in its planning stages, it is likely to start in the summer or fall of 2013, just before the state-based insurance marketplaces open for enrollment.
The still-unnamed campaign is likely to put more intensive resources toward a handful of key states. Those could include Florida and Texas, which have a combined 10 million uninsured residents, and have made little effort to do such outreach.
The group has raised $6 million from a coalition that includes the American Hospital Association, pharmacy chain CVS-Caremark, physician groups and individual health insurance companies. Although that initial funding has covered survey research and the hiring of seven staff members, board chairman Pollack said the group hopes to raise “tens of millions” more for the outreach campaign.
“We know now that the Affordable Care Act has to be implemented,” said Rachel Klein, Enroll America’s executive director. “It’s imperative that the people who will benefit hear about the new coverage available and learn how to sign up.”
Currently, 48.6 million U.S. residents lack health insurance. The Congressional Budget Office estimates that 30 million will gain coverage. That would leave nearly 19 million uninsured.
About a quarter of those are illegal immigrants, who aren’t eligible for the reform law’s subsidies. Two million, the CBO projects, live in states that will opt out of the Medicaid expansion.
The rest, however, probably are eligible for new benefits. The CBO, for example, expects that nearly 6 million of those newly eligible for Medicaid just won’t sign up for the program.
Even though the subsidies for currently uninsured people won’t go out until Jan. 1, 2014, the state exchanges that will offer health plans are being set up now, and participants will need to start signing up next Oct. 1. Supporters of the health-care law say the plan won’t be a success without a massive public relations campaign to build awareness.