The Shutdown Media Blitz Isn’t a Lost Opportunity to Sell Obamacare

The political class is consumed by the back-and-forth over the budget. But the political class is not who the administration needs to reach.

Call operators answer phones on the first day of Obamacare at an eHealthInsurance Services Inc. call center in Sacramento, California, U.S., on Tuesday, Oct. 1 2013. The Obamacare insurance exchanges struggled to handle a flood of consumer interest that closed the U.S. website for much of the day, and caused start up delays for most of the marketplaces run by the states. 
Bloomberg via Getty Images
Catherine Hollander
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Catherine Hollander
Oct. 3, 2013, 4:10 p.m.


In­stead of trum­pet­ing the rol­lout of the na­tion’s biggest health re­form in al­most half a cen­tury, the front pages of the largest news­pa­pers Tues­day blared head­lines about the first gov­ern­ment shut­down in less than two dec­ades. For Obama­care ad­voc­ates, this was a missed op­por­tun­ity for the ad­min­is­tra­tion to tell people they could now buy in­sur­ance, thanks to a law that still con­fuses most of the pub­lic. “It rains on their parade,” says Keith Nahi­gi­an, who helped design the Medi­care Part D pre­scrip­tion-drug en­roll­ment cam­paign in 2005-06 and now runs a com­mu­nic­a­tions-strategy firm. “This is the [first] day of a crown­ing achieve­ment of a ma­jor le­gis­lat­ive ac­com­plish­ment. And you only have one launch.”

But the pop­u­la­tion that will de­term­ine the law’s suc­cess is not ne­ces­sar­ily the same one track­ing con­gres­sion­al shut­down mach­in­a­tions. For un­in­sured, poor, or self-em­ployed Amer­ic­ans out­side of Wash­ing­ton, Belt­way-level in­terest in the House speak­er’s latest tac­tic or the pres­id­ent’s latest pos­ture may pose no real op­por­tun­ity cost. As of Au­gust, more than four in 10 Amer­ic­ans wer­en’t even sure if Obama­care was the law, ac­cord­ing to a Kais­er Fam­ily Found­a­tion health track­ing poll. For those people, out­reach is not all about na­tion­al head­lines and cable-news com­ment­ary.

The ad­min­is­tra­tion’s chal­lenge is for­mid­able. It needs to tail­or its ap­proach to reach the people whom the Af­ford­able Care Act ac­tu­ally tar­gets. The law will sub­sid­ize in­sur­ance in the on­line mar­ket­places for Amer­ic­ans earn­ing between 100 and 400 per­cent of the fed­er­al poverty level, and it will ex­pand Medi­caid eli­gib­il­ity in 24 states and D.C. Nearly three-quar­ters of the un­in­sured didn’t know in mid-Septem­ber that the ex­changes were weeks away from launch­ing, ac­cord­ing to Kais­er polling. The ma­jor­ity of un­in­sured Amer­ic­ans are in low-in­come, work­ing fam­il­ies. The highest con­cen­tra­tions are in Flor­ida, New Mex­ico, Nevada, and Texas. People of col­or are more likely to be un­in­sured; 32 per­cent of the non-eld­erly un­in­sured pop­u­la­tion is His­pan­ic, ac­cord­ing to sep­ar­ate Kais­er re­search. Two mil­lion rely on Span­ish, ac­cord­ing to an ad­min­is­tra­tion present­a­tion ob­tained by BuzzFeed this sum­mer.

“By and large, people get their news from their loc­al news sta­tion and the net­work,” says Stephanie Cut­ter, former deputy cam­paign man­ager to Pres­id­ent Obama and now a part­ner at con­sult­ing firm Pre­ci­sion Strategies. And the law did re­ceive a lot of cov­er­age in loc­al me­dia mar­kets on open­ing day, she points out. The ad­min­is­tra­tion has vowed to “turn up the volume” in these spaces with celebrity en­dorse­ments and ad buys. “Word of mouth is im­port­ant. Face­book is im­port­ant. Most of these people are prob­ably on the In­ter­net,” Cut­ter says.

Ac­cord­ing to the Pew Re­search Cen­ter, 79 per­cent of un­in­sured Amer­ic­ans are. But that leaves 21 per­cent who aren’t con­nec­ted. To reach them, the ad­min­is­tra­tion is lean­ing on in-per­son “as­sisters” and “nav­ig­at­ors,” who are paid to help people un­der­stand and sign up for in­sur­ance un­der the law — as well as on vo­lun­teer “Cham­pi­ons for Cov­er­age,” or­gan­iz­a­tions and busi­nesses that pledge to the Health and Hu­man Ser­vices De­part­ment that they will help sign up Amer­ic­ans for in­sur­ance through the ex­changes. Com­munity health cen­ters also re­ceived $150 mil­lion in grants to sup­port en­roll­ment. Rur­al pop­u­la­tions pose a par­tic­u­lar out­reach chal­lenge, HHS Sec­ret­ary Kath­leen Se­beli­us said at the Na­tion­al Rur­al As­sembly in June.

These in-per­son con­tacts will take time to es­tab­lish, and the law’s ad­voc­ates are play­ing up the long view. “From a me­dia stand­point, day one is a sign­post day,” says Ron Pol­lack, ex­ec­ut­ive dir­ect­or of the con­sumer group Fam­il­ies USA, which has paired its out­reach ef­forts with En­roll Amer­ica, the non­profit lead­ing ef­forts to get people signed up for cov­er­age. But “there still are a very sub­stan­tial num­ber of people who are un­aware of how the Af­ford­able Care Act can help them. So I think what will hap­pen in an ac­cel­er­ated way is that, in­creas­ingly, people will see oth­ers who they can identi­fy with who are get­ting help un­der the Af­ford­able Care Act, and that is go­ing to be the best way people get edu­cated about how this will af­fect their lives.”

A clin­ic run by Unity Health Care in Wash­ing­ton was bust­ling on the morn­ing of Oct. 1. A gov­ern­ment-trained en­roll­ment as­sister, 24-year-old Jorhan Santana, had briefed three people in the wait­ing room (one had Medi­caid; the oth­ers were not quite ready to sign up on the ex­changes yet). At his train­ing, he says, in­struct­ors had warned that “not every­body would come in for the first day.”

But in­terest — per­haps even driv­en by the shut­down caused by a dis­agree­ment over Obama­care — was strong. The volume of traffic to HHS serv­ers caused glitches, and the White House re­por­ted that 4.7 mil­lion people had vis­ited Health­, the site of the mar­ket­places, on the first day. (As of press time, the ad­min­is­tra­tion had yet to re­lease open­ing-day en­roll­ment num­bers.) “This isn’t Elec­tion Day,” says Anne Filipic, head of En­roll Amer­ica. “This isn’t a one-day ef­fort. This is a pro­cess.” And the sys­tem­at­ic, na­tion­wide health care over­haul likely won’t be stopped by shut­down mach­in­a­tions in Wash­ing­ton.

Ronald Brownstein contributed to this article.
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