To survive, Obamacare needs new customers

Francine Degni, left, gets some information about procuring health insurance through the Affordable Care Act from Shelley Winfield, Bellevue Hospital Center's Community Advisory Board.
Francine Degni, left, gets some information about procuring health insurance through the Affordable Care Act from Shelley Winfield, Bellevue Hospital Center's Community Advisory Board.

Laura Wallach took the morning off from work just to learn more about signing up for Obamacare. 

“I’ve heard pretty much only good things about it," said Wallach, 25, describing positive feedback from her family and friends covered by the new exchanges this year. On Friday, she carved out time from her non-profit temp job to attend a free workshop at Manhattan's Bellevue Hospital. 

But though it was listed on the New York Health Exchange’s website as an open enrollment event, the four-hour workshop mostly focused on Medicare, with just one hour at the end devoted to Obamacare. 

Wallach left shortly after the first hour's PowerPoint on Medicare, which she won't qualify for another 40 years. But she's planning to continue her search for Obamacare information back home in Queens, hoping to find someone to help her navigate the marketplace. "It's all Greek to me," she says.

Laura Wallach, 25, of Queens, New York, is looking into coverage through the Affordable Care Act, as she will soon be too old to continue health coverage under her father's plan.

Educational and outreach efforts will be critical to ensuring that the nascent health care exchanges continue to gain momentum in Obamacare's second year. Open enrollment for the exchanges begins on Saturday, and health advocates are focused both on re-enrolling those already covered — and signing up those who didn’t get coverage the first time around. 

The next round of Obamacare participants will be generally harder to reach, as many may have declined to get coverage the first time around or simply didn’t know about the options available. Health advocates are targeting specific populations in particular: Latinos, who have not gained insurance as quickly as other racial or ethnic groups; young people, who are generally healthier and whose participation helps reduce insurance costs for everyone; and people who are middle-income earners but still qualify for Obamacare’s subsidies. Wallach is already a beneficiary of the Affordable Care Act: The law has allowed her to stay covered on her father’s insurance plan after she left her full-time job in D.C. Saving on health insurance helped fund her move to New York and reunite with her long-time boyfriend. But Wallach will lose the ability to share her parents’ coverage when she turns 26, prompting her to look for other options. “I’m on medication that I want covered, and in general, it’s a terrifying prospect not to be covered,” she explained. 

“Many of those who enrolled in 2014 were people who had chronic conditions and generally had a lot of demand, or who were particularly low income and benefited the most from the subsidies in the exchange,” said Caroline Pearson, vice-president of Avalere Health, a D.C.-based research and consulting firm. 

So this year, health officials and advocates will need to convince those who are relatively healthier and net higher incomes to sign up for Obamacare. “People who have a little bit less demand for health insurance, who are a little bit less aware” of the exchanges, explains Pearson. 

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About 7.1 million people are currently covered by the exchanges, and the White House expects as many as 10 million to be enrolled by 2015. Insurers are also betting that new consumers will continue flocking to the exchanges, with 25% more people expected to participate this year. But it’s uncertain exactly if and when new enrollees will decide to sign up. “I don’t think everyone really knows how long it takes to get people engaged who didn’t buy the first year,” said Gary Claxton, vice president of the Kaiser Family Foundation.

Basic information about the exchanges has yet to reach most uninsured Americans: About 90% aren't aware that open enrollment begins in November; 66% know "only a little" or "nothing at all" about the Obamacare exchanges; and 53% aren't aware that financial help for insurance is available to lower- and moderate-income Americans, according to an October poll from the Kaiser Family Foundation.

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Health care advocates are hoping to break through by drawing from lessons they’ve learned this past year. One outside group, Young Invincibles, has found that big events “with something fun” are particularly effective at reaching young people. The group’s ACA enrollment event at the University of Houston this week featured a free Zumba class and line dancing, for instance.

Health care advocates are also prioritizing the role of one-on-one help from assistants known as "navigators," who proved particularly effective in reaching minority communities. “Our research demonstrated that those who received in-person assistance were twice as likely to have completed the enrollment process,” said Anne Filipic, president of Enroll America. Enroll America, a health care advocacy group, found that many who didn’t sign up last year thought they couldn’t afford insurance, so they’re stressing the financial assistance that’s available. Individuals earning as much as $46,680 and a family earning as much as $95,400 in 2015 are eligible for tax credits to help pay for coverage. “There is a huge need for consumer education, as well as misconceptions about the cost,” said Erin Hemlin of Young Invincibles, which highlights the fact that about 85% of those currently enrolled in Obamacare’s exchanges receive subsidized coverage.

Outreach groups and officials are hoping to remedy some of the mistakes made last year, including a shortage of Spanish-speaking staff and delays in the Spanish-language version of, among other obstacles, as The Wall Street Journal explains. Young Invincibles has hired a Spanish-language media coordinator to help reach young Latinos, after the group found that language barriers proved to be a significant obstacle last year.

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The government, meanwhile, is trying to avoid a repeat of the massive technical problems that plagued the exchanges’ websites last year. Many current consumers will be auto-enrolled in the same plans, which should reduce some of the web traffic slowdowns. They’re being encouraged to shop around, however, as many could see their premiums rise if they stay in the same plan through 2015. But those currently enrolled have also given advocates a new tool in their arsenal as well: Satisfied customers.

A new Gallup poll shows that more than 70% of those enrolled through the exchanges rate their coverage as “excellent” or “good.” Only 17% plan to get coverage outside of the exchange in 2015 or drop coverage altogether. Costs in individual plans could rise, but premiums are expected to remain largely flat on average, or even drop slightly in some markets. “We’ve gone back to some of the people who enrolled the first time to share their stories,” said Hemlin.

The political opposition to Obamacare hasn’t let up, however. With a new majority in the Senate, Republicans have vowed to stop the law. And a new Supreme Court case challenging the federal exchange’s subsidies could also put the law’s future in jeopardy. 

Wallach feels confident that Obamacare will stay in place, but she wants to make an informed choice when she signs up. 

Before leaving Bellevue Hospital, she got a few numbers for local navigators near her home in Woodside, Queens. She’s planning to use the time she took off from work on Friday to track them down. “It’s worth the investment in the long run,” she said.