Why Obamacare’s Success May Hinge on a Website

Who's winning, who's losing, and why.
Sept. 26 2013 3:49 PM

The Medium Is (Most of) the Message

Why Obamacare’s success may hinge on a website.

U.S. President Barack Obama
The Affordable Care Act's chief evangelizer may not be President Obama, but healthcare.gov.

Photo by Alex Wong/Getty Images

On Oct. 1 Americans will begin to sign up for health care plans as part of the Affordable Care Act. Despite all the efforts to sell Obamacare, a majority of Americans are still fearing the day. According to the latest CBS News/New York Times poll, 51 percent of Americans disapprove of the health care law and only 39 percent approve of it. Seventy-nine percent believe implementation will either not affect them or leave them worse off. On the eve of this long-fought-over moment—the day Obamacare takes affect—President Obama’s best sales tool may come down to a website: healthcare.gov.

John Dickerson John Dickerson

John Dickerson is Slate's chief political correspondent and author of On Her Trail. Read his series on the presidency and on risk.

That’s because that website will be able to give people real numbers about how the plan will affect them specifically—the abstraction will become a reality. "You may have heard a lot of things, but check it out for yourself," says David Simas, a White House deputy senior adviser working on the rollout, imagining a conversation with a skeptical consumer. "That young man will go online, fill out an application that will probably take him eight minutes, and the first thing he is going to see, depending on his income, is that he is getting money. You get a subsidy of $1,000 or $1,500, and we have seen with young people—and older people—when they see right away [that they get a subsidy], that changes immediately the perceptions of affordability."

Simas, the much-praised director of polling and research for the Obama 2012 campaign, is meticulous about data, so he was careful to manage expectations in a Wednesday morning session at the think tank Third Way. He doesn’t expect a wide swing of people rushing headlong into the program. He expects enrollment to be slow in the first two months with an uptick before Jan. 1, 2014, when coverage starts. Simas expects between 4 million and 9 million of the 40 million uninsured Americans to sign up in the first year. (The Congressional Budget Office has predicted 7 million will sign up.)

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Bill Schneider, the CNN political analyst and host of the event, asked Simas about the most important and hard-to-reach customer he’s hoping to sign up: the under-30 apathetic slacker. (Schneider said he’d been asked about the Affordable Care Act by just one such specimen at a Walgreens; the fellow referred to Schneider as a “news dude.”) If millions in this age group don't sign up, the health care premiums will rise as insurance plans are stuck with only older or sicker customers. These younger Americans are irritated that they have to sign up, and remain skeptical that they will need the coverage. Some may decide to just pay the fine and not bother with the homework assignment. The website optout.org, funded by the Koch brothers, is encouraging them to do just that. 

"[The Koch brothers] have a profound misunderstanding of the people they are trying to approach," says Simas, who spent much of the last few years getting these young people to vote for Barack Obama. His argument is that three out of four young adults are open to buying insurance because they think it is valuable. What gives them pause is the cost. If Obamacare can come in under $100 a month, says Simas, they are likely to sign up.

That's where the healthcare.gov website comes in. When users sign in, they will be asked to plug in their income, age, and state. Most will be surprised to learn that they qualify for federal subsidies if their income is low enough. Some will find that they qualify for Medicaid if they live in one of the 26 states that have accepted the federal funds. Simas points to the example set by Mitt Romney in Massachusetts. Twenty-six percent of the state’s young people were uninsured. After Romney’s plan was introduced, it shrunk to 6 percent.

Simas’ argument must overcome two headaches. First, is it true that young people value insurance?  The administration's own social media campaign lists one of the core problems in reaching young, healthy Americans is that they don't see the "value" of insurance, not that it is too expensive. Second, as effective as the website may be, will uninsured Americans even visit it? A Commonwealth Fund study found only 27 percent of 19-to-29-year-olds are aware of the health insurance marketplaces.

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