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The Many Ways To Sell Obamacare

During a visit to California in early June, President Obama began in earnest his sales pitch for U.S. residents to enroll in health insurance provided under the Affordable Care Act.

While in San Jose, the president said, “The main message I want for Californians and people across the country [is that] starting Oct. 1, if you’re in the individual market, you can get a better deal” through state health insurance exchanges.

While health care wonks have debated whether the exchanges actually are a better deal, the Obama administration has continued to hammer this message home, not just because it wants people to pay less, but because it needs as many residents in the exchanges as possible.

The outreach effort involves a multipronged promotional campaign, and the White House has sought to include a variety of organizations in the effort. Unsurprisingly, the strategy has drawn Republican ire, but it’s also involved several groups that no one expected to see in headlines next to “Obamacare.”

Promoting the Law’s Benefits

One arm of the outreach effort is powered by advocacy groups. Organizing for Action and Enroll America both launched advertising campaigns last month.

In its first 30-second television advertisement, OFA — a spinoff of the group behind President Obama’s 2012 re-election campaign — focuses on U.S. residents who have benefited from the ACA. The advertisement touches on residents’ ability to access no-cost preventive care and receive savings through the medical-loss ratio.

According to the Associated Press, the group plans to spend about $1 million on ads this summer.

Meanwhile, Enroll America said that it will use paid media ads and “comprehensive digital outreach” to educate residents about their options under the ACA. The group also plans to increase its staff from 50 to 275 workers.

Ron Pollack, chair of Enroll America’s executive board, told the media that the group’s budget is “well into … eight figures,” adding, “The hope is we make a huge start, and as more and more people get coverage and tell their neighbors and friends about the coverage they receive, the word will spread significantly.”

Trying To Attract Young, Healthy People

The Obama administration seeks to have about seven million individuals across the U.S. enroll in state health insurance exchanges. Officials say that about 2.6 million of them need to be young and healthy individuals to help keep costs down for the overall pool of enrollees.

As part of that effort, the White House has reached out to major professional sports leagues and celebrities.

HHS Secretary Kathleen Sebelius has confirmed that she discussed ACA promotions — including paid advertising and partnerships — with the National Football League. The agency also reportedly has contacted the National Basketball Association, and a spokesperson for Major League Baseball said the organization had been contacted by federal officials.

Further, the administration is seeking celebrities to promote the ACA, including Eva Longoria, Jay-Z and Beyoncé, Pearl Jam guitarist Mike McCready, Pitbull and others.

Encountering Roadblocks

Criticism and controversy have followed both outreach efforts.

Enroll America sparked an investigation by House Republicans that zeroed in on Sebelius’ requests for private donations to the campaign.

In March, the HHS secretary began soliciting private donations in the face of lower-than-expected funding to implement the ACA. HHS in April confirmed that Sebelius made the donation requests, but a spokesperson said her actions are not illegal or improper because she did not make fundraising requests to any groups regulated by the department.

In May, House Republicans sent letters to Sebelius and more than a dozen insurers and organizations requesting details about their roles and contributions to the campaign. Sebelius explained and defended her actions in testimony before the House Education and the Workforce Committee earlier this month.

In further congressional scrutiny of ACA outreach, Rep. Steve Scalise (R-La.) — the leader of the Republican Study Committee — last week sent a letter to league commissioners at the NBA and the NFL urging the organizations not to help promote the ACA.

In the letter, Scalise warned NFL Commissioner Roger Goodell and NBA Commissioner David Stern that the ACA could negatively affect their fan base by raising health insurance premiums and discouraging hiring. He wrote, “I contend that the effects of this train wreck will have a devastating impact on your fans and business partners across the country.” He added, “I would caution you against being coerced into doing [the Obama administration’s] dirty work for them.”

Scalise also asked the league commissioners if Sebelius has pushed the leagues to donate to groups “aiding in the promotion or implementation” of the law.

Mandy Cohen, a senior adviser at CMS, defended the administration’s effort to reach out to professional sports leagues. She told The Hill’s “Healthwatch” that the partnerships are not about politics but “about health and improving health.”

“There have been multiple stories in the paper about how the NFL struggles with their own internal players and making sure they have proper health coverage,” she noted, adding, “So I think there’s just an alignment of mission across the board.”

Perhaps none of the outrage over outreach involving professional sports leagues will even matter. Just last week, Obama administration officials received a very public rejection from the NFL.

On Friday, NFL spokesperson Greg Aiello said the league will not make any commitment to the administration.

“We have responded to the letters we received from members of Congress to inform them we currently have no plans to engage in this area and have had no substantive contact with the administration about [ACA] implementation,” he said.

Looking Ahead

There is little question that the Obama administration must boost outreach for the ACA to be successful. The latest Gallup poll shows that while 81% of U.S. residents are aware of the law’s requirement that most individuals must obtain health insurance, about 43% of uninsured individuals don’t know about it. Meanwhile, a 2012 survey by Democratic polling firm Lake Research Partners found that 78% of the uninsured Americans who likely would qualify for subsidies were unfamiliar with the new coverage options.

Whether the ACA succeeds depends in part on the efficacy of various outreach campaigns, some of which rely on the help of organizations that Americans normally do not associate with health care policy.

However, history has shown that such organizations can help send messages to groups of residents who politicians struggle to reach.

Massachusetts was the first to use the idea as the state prepared to launch its 2006 health reform law, which is considered to be a model for the ACA. According to state officials, a marketing campaign that incorporated the Boston Red Sox helped drive residents to new coverage opportunities. Massachusetts officials have said they are considering a similar approach to promote the ACA.

Hedging its bets, the Obama administration is considering other unexpected strategies — such as enlisting the help of libraries — to teach residents about the law, as the insurance exchanges’ enrollment period inches ever closer.

According to Sebelius, “We’re doubling down on efforts to make sure that our partners on the ground — the stakeholder community, provider community, our partners across U.S. government — are actually helping in this effort to do outreach and enrollment. We never anticipated that this could be a government-only outreach effort.”

Weekly Roundup

Here’s a look at other health policy-related issues making headlines.

  • The care up there: Sarah Kliff in Washington Post‘s “Wonkblog” explains why Obamacare is nothing like the socialized medicine system in Canada.
  • A premium problem: Avik Roy in Forbes‘ “The Apothecary” highlights another analysis of expected premiums under the ACA, which found that they could double or even triple for some policyholders.
  • Working out the problem of workplace wellness: The Disease Management Care Blog links population health, a Journal of the American Medical Association viewpoint on personalized medicine and a Wall Street Journal editorial on workplace wellness.

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Road to Reform The Health Law