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Obamacare’s Biggest Challenge May Turn Out Not to Be Republicans

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TRUE talked to GMMB’s David Smith and Alison Betty about the communications challenge facing the new health insurance exchanges that open October 1.  Mandated by the Patient Protection and Affordable Care Act of 2010 and run by the states or the federal government (in cases where states didn’t start their own), the exchanges are a marketplace where consumers can shop for affordable health coverage. Smith and Betty represent a group called Enroll America, comprised of a coalition of healthcare consumer advocacy groups such as Families USA, health insurance companies such as Blue Shield of California, and health care providers, such as the American Hospital Association.

Q: What do you see as the biggest challenge the states face as they try to educate the American public about the new health exchanges?

Alison Betty: The biggest challenge is probably the most basic—making Americans aware of the exchanges. We have the polls that show potentially as much as 60 to 80 percent of the public is unaware.

Q: How can that be given the nonstop debate in Washington that has continued even after passage of the law?

Betty:  So much of that discussion has been about the politics and not really what the everyday consumer needs to know or thinks about related to their health insurance. So the states face the very basic task of describing what this really means for people and for families who have been struggling without insurance, putting it in real terms for them, because these are really significant improvements, not just politics.

David Smith:  And sadly the lack of awareness is particularly prominent among the lower income folks who are most likely to be eligible for the health exchanges and the tax credits or Medicaid expansion to help them afford the insurance. They’re not following the political debate in Washington.  It’s all a lot of mumbo jumbo to them. This is a population that has been completely shut out of the private health insurance market for many, many, many years. Health insurance hasn’t been an option for them: It’s too expensive; it’s impossible to navigate once you find it. There’s so much fine print; it’s very confusing. They haven’t seen options out there for them in the past. So the biggest challenge is to help this very skeptical disengaged audience to understand that it’s now, in fact, possible.

Betty: They really value health insurance, so we don’t have to do a lot of work to explain why health insurance is important. We have to help them gain confidence that they will succeed in finding a health plan that fits their family needs and fits their budget, given how unthinkable that has been until now. And we’re talking millions and millions of people, mostly uninsured or those who have been buying insurance in the individual market on their own. They’re really eager for something more in their reach.

Smith: The good news is, there are messages that resonate with this audience. If you look at a lot of the research that has been conducted nationally and in states across the country, it is very consistent across all the different groups, whether you’re the young invincible or eligible for Medicaid, or a new retiree, or a mom. It boils down to three key points: number one is this idea that there’s a new way to get health insurance, that there are new plans available that have never been available before.

The second point is that there’s help being offered. There’s financial help through Medicaid or tax credits. That’s a huge, huge message for these folks, because obviously cost has been the biggest barrier. There’s also help in the form of experts available online, on the phone or in person who can help them navigate the enrollment process.

And finally, the third really important point is the idea of the medical care available once you and your family are covered. Nobody plans to get sick or injured, but when the unexpected happens, now you’re going to be covered, and it’s not going to break the bank, it’s not going to force you into bankruptcy.

Betty: And with half of the country having a chronic condition, the fact that you can’t be denied coverage because of a pre-existing condition is monumental here.

Q: What about the cost? Will it be affordable?

Betty: On the exchanges, we’re seeing some pretty fascinating behavior by the insurance companies. In Oregon, there was an insurance company that saw the rates that were submitted by the other plans and went back and resubmitted lower rates, across the board. I’d say generally, we’re seeing rates lower than expected, certainly lower than critics predicted, and often lower than previous years. What we are seeing is insurance companies going directly to consumers, pitching their plans, trying to woo consumers directly to their plans, whether they have plans on or off the exchange and prior to October 1.

Q: How prepared do you think states are for this October 1 rollout of health exchanges?

Betty: I think they’re pretty well prepared. This is unprecedented. We’ve never done anything like this, but I am frankly in awe of the staffs at all of these exchanges across the country, and what they’ve pulled off over the course of only a few short months. They’re building IT systems; they’re creating education and outreach plans; they’re reworking eligibility systems; they’re really looking at how they’re managing health coverage in their own states, and coming up with new ideas and new plans and new systems. There’s so much media coverage right now about not being ready for Day One, but I think what we will see play out over the course of the next few months is a very robust and successful open enrollment period. People have six months until March 31 for this first time around and I think we will see millions of people get enrolled. It won’t happen on Day One but it will happen.

Q: But won’t this experience play out differently in the various states? Some states are committed to getting their citizens enrolled and others are opting out and leaving it to the federal government.

Smith: I think that’s right, and that’s going to be interesting to see how it rolls out state by state. There’s no question that states that are creating their own exchanges have a much more robust public education effort in place, and certainly the resources to do that throughout the open enrollment period. Then there are states like Missouri where they’re not building their own exchange, or states like Texas and Florida where they’re not expanding Medicaid, it is going to be much more difficult to get the word out in those places. Nonprofits are working to fill in the gaps, and HHS will also do marketing targeted to those states. That’s going to be part of what’s interesting, a little bit of experimentation here to see what works.

Q: How has the education campaign been affected by the efforts to defund the law and the advertisements that have been running discouraging people from taking advantage of the insurance plans on the exchanges?

Smith: The advertising that’s happening now represents a new and far more troubling direction. It’s basically telling people they don’t want the policies that the exchanges have to offer, so better to go uninsured. We just don’t know yet how it is playing out.

Q: How should we judge success? Because I’m sure there’ll be a rush in the media to make a call, “successful, not successful,” based on early numbers.

Betty: I think we judge it by a steady stream of enrollment. There’s a lot of research that goes into health insurance, and consumers have a lot to learn. The education process will take time. So I think we need to be judged by the steady stream of people that enroll over that six-month period.

Smith: Remember on October 1, we’re all going to wake up and nothing will be very different—those who had insurance will still have it and those who didn’t still won’t. But on January 2, it gets interesting because thousands, and maybe millions, of people are going to wake up and have insurance for the first time.

Q: What happens if the health exchanges and health reform are not successful?

Betty: That’s just not a possibility. We don’t entertain it. Because the reality is, the cost of doing nothing is dramatic. We live in a country where 26,000 people a year die simply because they don’t have health insurance and had to delay care.  And that’s just not acceptable.

Photo credits: Girl at doctor, homepage (Zave Smith, Getty Images); Obama (Getty Images); volunteer, (Getty Images)

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About the author

David Smith is a partner at Washington-based GMMB, an advertising agency known for its creative, PR and consulting work with nonprofits, advocacy groups and political leaders. He leads campaigns for political candidates and coalitions to promote policy change, particularly in health care reform. Here, he represents Enroll America, a nonprofit assisting the government in its education efforts about the health exchanges created under Patient Protection and Affordable Care Act of 2010. Among its board members are representatives from Kaiser Permanente, Blue Cross of California, Teva Pharmaceuticals, Families USA, American Hospital Association and Maryland Citizens Health Initiative.

Alison Betty also is a partner at GMMB and manages a diverse portfolio of projects in health care and public policy. She also is working with Enroll America.