The Patient Protection and Affordable Care Act isn’t as old as you think, but its history has already been long and arduous. Three years after President Obama signed it into law, it’s still overwhelmingly confusing—not to mention unpopular—among Americans across all demographics.
Sure, the law survived a Supreme Court case and a presidential election, but it hardly escaped unscathed. Many more states than expected refused to set up their own health care exchanges, instead defaulting to the federal government. House Republicans are still holding votes to repeal PPACA, though the motion isn’t likely to make it past the Democratic Senate. Carriers are proceeding with caution when it comes to setting up shop in the public exchanges while industry veterans warn of impending doom.
But perhaps the biggest challenge has been the average American. Poll after poll has found the same thing: The majority of the country still opposes the law, and perhaps even worse, they don’t understand it.
Kaiser Family Foundation underscored the problem in its latest health tracking poll when it found that nearly half of Americans don’t even realize PPACA is still law and is being implemented. And worse yet, the people who stand to benefit the most are the least aware of the changes that are coming. According to Kaiser’s poll, 58 percent of the uninsured and 56 percent of low-income households say they lack enough information to understand how PPACA will affect them.
So with all of this in mind, just how do you market something so many people are either against or blissfully unaware of?
That’s the challenge for Enroll America—a nonprofit group formed in 2011 to get the word out about PPACA—and its president, Anne Filipic.
Filipic admits it’s a big undertaking.
“There are millions of uninsured Americans across the country,” she says. “The new law is a big deal—a big win—for consumers. And many are really unaware of the opportunities. We have a challenge to raise that awareness to them.”
Enroll America is an umbrella organization for groups that will promote PPACA’s insurance exchanges, new online marketplaces where millions will shop for coverage starting Oct. 1.
Though a number of organizations are working nationally on enrollment—including the Obama administration and insurers and advocates—Filipic says Enroll America is in a unique situation because it brings all those groups together.
The success of the law depends on enrollment. Without participation, experts warn, health care costs may surge because not enough healthy people will participate to offset benefits payouts. That’s aside from the rate shock that’s already been plaguing some consumers under PPACA.
Beginning Jan. 1, uninsured Americans will be forced to pay a penalty of either $95 or 1 percent of income, whichever is greater, if they don’t buy insurance. The fine increases each year.
Enroll America’s goal is simple: To educate the public about the changes coming, and what the new law means for them and their families, Filipic says.
“We are working on maximizing the number of uninsured Americans to enroll in health coverage through [PPACA],” says Filipic, 31, from her office in Washington, D.C.
This summer marks the beginning of Enroll America’s big campaign push, called “Get Covered America.” The focus, Filipic says, is to educate consumers about the benefits of health insurance coverage and the new options available to them under PPACA.
There’s a lot of ground to cover: There are roughly 48 million uninsured U.S. residents. The Congressional Budget Office estimates 30 million will gain coverage.
The campaign—which is expected to cost tens of millions of dollars—is using tactics of a typical political campaign, including online organizing, grassroots outreach, paid advertising, and volunteers and staff going door-to-door in communities.
“What we are really focused on is having a presence in communities across the country and really building a full campaign that creates kind of an echo chamber for consumers and meets them where they are, in their communities,” Filipic says. “We want to give them the information they need to make a decision that is very personal and really allows them to choose a plan that works for them and meets their family budget.”
The group will target people in churches, in community health centers, in businesses—the list goes on. The outreach is helped by partnerships with community leaders, hospitals and insurers, Filipic says, partnerships “we’ve been working to build since Enroll America’s inception in 2011.”
Also a part of the role, Filipic insists, is health insurance brokers and agents.
“[They’re] trusted messengers and will be one important part of a multi-pronged effort to provide consumers with the information they need to apply for coverage and choose a health plan that’s right for them,” she says.
Though the campaign is nationwide, the group will devote more resources to states that are plagued by high uninsured rates, including Texas, California, Florida and Illinois. States like Texas and Florida are also where opposition to the legislation has been especially strong.
The organization is counting on “word of mouth success,” Filipic says.
“When [consumers] start to enroll and find options for them, they’ll tell their family members or neighbors,” Filipic says. “And then we’ll start to see a ripple effect.”
But before that happens, Enroll America needs to “help people move to where they want to be.” That was one of the main findings of a survey the organization commissioned to help hone its message. Lake Research Partners, a Democratic polling group that conducted the survey, found that in addition to being unaware of their options under the new law, most Americans said the process of finding insurance was mentally and emotionally draining. When consumers were asked what feelings they would have if they had to look for health insurance now, they used the words “helpless,” “frustrated,” “stressed,” “overwhelmed,” “confused,” “worried,” and “angry.”
Many Americans are skeptical of the law and the promise of “quality, affordable health coverage.”
It’s a fact Filipic acknowledges.
“It’s not that they haven’t looked or thought that health coverage wasn’t important; it’s that for whatever reason they couldn’t find something that worked for them,” she says.
A recent survey from InsuranceQuotes.com found that more than three in five uninsured Americans say the main reason they currently lack health insurance is because they can’t afford it. But those uninsured also said they don’t believe PPACA will make the law any more affordable.
Enroll America’s survey found similar results. When given a brief description of the exchange, 37 percent of respondents said they thought they’d be able to find an affordable plan. But once the respondents saw hypothetical premium amounts, perceptions of affordability dropped to 29 percent.
Because of those results, Lake Research Partners actually suggested Enroll America not cite specific dollar amounts to consumers, as “using a specific premium amount may actually turn away just as many people as it might motivate.”
According to InsuranceQuotes.com, almost two-thirds of uninsured Americans haven’t yet decided whether they will purchase health insurance by the Jan. 1 deadline. That’s a big number, considering Oct. 1—the date when open enrollment for those plans begins—lingers only a couple of months from now.
But Filipic is hopeful. She likes to talk about the many choices consumers will have under Obamacare. Plus, there are some things that might help ease skeptics’ minds: the health subsidies available for low- and middle-income consumers under PPACA, for one, as well as popular provisions like the pre-existing condition provision and the under-26 provision that allows young adults to stay on their parents’ health plans.
The law, of course, has been plagued by politics. Support is largely divided by party affiliation, with Democrats much more heavily supporting the law than Republicans. It’s something Filipic says is a big—and understandable—barrier to success.
Although Filipic comes from the Obama administration, having served as deputy director of the White House Office of Public Engagement, she wants to keep politics out of the conversation, admitting it turns people off and away from the main message. She is adamant that Enroll America is “completely nonpartisan,” though politics already have gotten in the way.
Health and Human Secretary Kathleen Sebelius has come under heavy criticism from Republicans for her fundraising work for Enroll America. Sebelius admitted she made calls to organizations and carriers on behalf of the organization, asking them to contribute to their efforts. While the administration has said previous administrations have done the same thing, Republicans have suggested she may have crossed legal or ethical boundaries.
Filipic says those issues miss the point of the organization. Enroll America is important because getting people health insurance is important. Period.
“The conversation around [PPACA] has been political. But really what this is all about is a consumer-focused conversation,” she says. “And that’s what resonates with folks. The people who are working hard, raising their families, day to day, what is going to reach them is when we start talking about it in a way of ‘What does this mean for you and your family?’
“And when the conversation becomes about that, it will resonate more with folks.”
Oct. 1—the date when open enrollment begins in the states—is now just a few months away. While Filipic acknowledges it’s a big date for both the administration and her, it’s not a ticking time bomb.
“We see the importance of that date,” she says. “It’s when the new options become available, so it’s important that [consumers] have a clear sense of that. But the work is just beginning in October. It will be a long process.”
Photography by Brad Howell