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Obama's signature on Affordable Care Act
President Obama's signature on the Affordable Care Act
Now that it's clear that Obamacare is indeed the law of the land (for everyone but Michele Bachmann, anyway) states that have decided to set up exchanges have a new challenge to meet, and not a lot of time to do it. They need to get the word out to state residents that insurance exchanges are coming.
The challenge, of course, is that the exchanges won’t work unless people—including younger, healthier people—sign up in these new marketplaces. And people won’t sign up if they don’t know what an exchange is, how to find one or whether they are eligible. And after all the political fighting about Obamacare, there’s a lot of confusion out there — and not a lot of time to educate the public before enrollment starts in October. Coverage starts in January 2014. [...]

“The uninsured population is an extremely difficult population to reach,” said Michael Marchand, director of communications for the Washington State Health Benefit Exchange. “They’re uninsured for a reason. How much will it actually take to get people both understanding the value [of the exchange] … as well as taking action to enroll?” [...]

Among the nonconventional ideas they’re floating: partnering with local soccer clubs, printing ads on prescription drug bags and advertising on Pandora. But they’re also planning on investing heavily in more traditional radio and television advertising, particularly for the Hispanic population.

A difficulty in reaching this population of uninsured is that many are the working poor who might not be actually poor enough to be looped into state assistance programs, and therefore not easy to reach. The challenges are greater for conservative states where politicians have been trashing Obamacare for years and now have to explain that there actually will be some benefit to state residents.

In some of these states, the success of the program might be boosted by a national effort. The federal government will be taking on the task of informing residents that exchanges are coming in the states that have refused to set up their own, but should probably extend that effort into states, like Idaho, where the exchanges are being set up by reluctant governors. There's no reason not to believe that some of these governors or legislatures wouldn't be inclined to sabotage the program they hate so much by doing a half-assed job of implementing it and advertising it.

Originally posted to Joan McCarter on Thu Jan 10, 2013 at 08:08 AM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (15+ / 0-)

    "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

    by Joan McCarter on Thu Jan 10, 2013 at 08:08:47 AM PST

  •  Seems to be going remarkably well in MN (0+ / 0-)

    There was significant coverage on local TV last night about the exchanges coming in October.  Even the Republicans are cooperating.  I expect we will continue to see plenty of free advertising from local media as well as proactive advertising from the state.  

  •  it seems to me that simply having state health (1+ / 0-)
    Recommended by:

    officials go to local news media outlets throughout each state, including radio, television and newspaper outlets, to discuss this, should help a lot.

    •  I have a lot of questions about this myself. (2+ / 0-)
      Recommended by:
      wdrath, ferg

      I live in California and my husband and I both have employer provided health insurance and we have the option of insuring our kids through our plans. This is incredibly expensive and the plans provide little coverage with high copays and deductibles.

      Will we be able to insure our kids through the exchanges or are they just for people without insurance? If we take them off insurance do we have to wait for a period of time?

      I was wondering because a lot of people have expensive health insurance and would like to find a cheaper option.

      Since when is the party that embraces all the top tenets of Satan allowed to call the God shots?--wyvern

      by voracious on Fri Jan 11, 2013 at 02:17:52 PM PST

      [ Parent ]

      •  Unless the law was changed at some point, folks (0+ / 0-)

        who are eligible for coverage under "Group Health Insurance" at their place of employment are not eligible for go through the insurance exchanges.

        Chance are that it would be more expensive, anyway, than what a major employer can offer their employees at group rates.

        Especially if you're in your fifties or older.


        “If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

        by musiccitymollie on Fri Jan 11, 2013 at 03:54:34 PM PST

        [ Parent ]

        •  I am in a state that is NOT setting up its own (0+ / 0-)

          exchange.  It has offered uninsured folks catastrophic coverage (without a subsidy) for years.  The worst plans run about $1,000 monthly for folks fifty years and older.

          That's why I figure that you'd not gain much by switching.


          “If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

          by musiccitymollie on Fri Jan 11, 2013 at 03:58:41 PM PST

          [ Parent ]

  •  I can't help it to say - well paid (0+ / 0-)

    if the states would have supported a real public healthcare system, similar to medicare for all, they wouldn't have that problem and now most probably they won't reach those, for whom the ACA has benefits.

  •  Maybe they should hire (2+ / 0-)
    Recommended by:
    DontTaseMeBro, ImABlondOK

    Justin Bieber or Kim Kardashian to do ads for it..

    "This ain't no party, this ain't no disco, this ain't no foolin' around..."

    by cgvjelly on Fri Jan 11, 2013 at 02:08:21 PM PST

    •  Wait! No! It should be "Grouchy Cat" (0+ / 0-)

      Grouchy Cat acts all put out and grouchy because he / she watches Fox Snooz... but discovers how amazing Obamacare actually is... and cracks a slight smile.

      Memes like these spread more quickly, and socially... and will be very popular.

      Spray tons of carcinogens into the ocean to hide petroleum spewed from a hastily-drilled hole from a greedy corporation, but don't smoke pot. -xxdr zombiexx

      by DontTaseMeBro on Fri Jan 11, 2013 at 02:15:23 PM PST

      [ Parent ]

    •  It needs to be someone normal humans won't mute (0+ / 0-)

      immediately during the commercial break, preferably someone who is either respected or beloved. Does anyone know the political affiliation of SpongeBob SquarePants?

      "When in doubt, do the brave thing." - Jan Smuts

      by bunnygirl60 on Fri Jan 11, 2013 at 03:05:03 PM PST

      [ Parent ]

  •  California State Gov't is focussed on this (3+ / 0-)
    Recommended by:
    Dogs are fuzzy, tb mare, dkosdan

    And has been reaching out to nonprofits serving low-income and immigrant communities to get the information disseminated in an effective and thorough way.  Just this week I head a report from the director of a legal services provider on the coalition being built to advance this need.

    It will certainly be challenging; it's a new world.  The real compliance may only occur when the fines/taxes begin to be levied on the uninsured.

    •  I was reading today that in the new CA budget (1+ / 0-)
      Recommended by:

      they budgeted money for people who are eligible for medicaid but who have not signed up - somehow those people are "covered." Not sure what this meant, but it sounded proactive.  The amount was something around $300,000,000.

  •  They also need to be informing people that this (0+ / 0-)

    is a thing they will need and want but also that is will be mandatory.  I am seeing in my own students when we talk about this, that there are some who still think this is up for debate or something....or if they don't want it, then it's just no big deal.  

     Some of my student's are still on their parents' plan up until they are 26 but a lot of them are saying that "they can't afford it" or " I don't file taxes anyway" or "It will be repealed" or "I'm not paying for that" or whatever excuses.

    Somehow the message needs to get out to young people and other groups who may be more reluctant to actually buy insurance...that this is indeed a law now, just like their car insurance and that it is a good advantage for them to go ahead and shop around to find the best way to comply with the law.

    •  They'll also be fighting . . . (0+ / 0-)

      The administration will also be fighting the disinformationists, folks who will lie about the ACA and its benefits to discourage people from signing up or even investigating what it's all about. Why will there be folks doing this? Because they can. How can I be so sure? I've been watching them for the last 30 years or so.

  •  Many young people won't see the benefit. (2+ / 0-)
    Recommended by:
    SpamNunn, musiccitymollie

    Someone barely making enough to get by but not poor enough to be in Medicaid will have to pay monthly premiums. But, the coverage will likely include deductibles and co-pays that still makes health care financially out of reach. So they'll get to pay a lot of money for little or no actual health care.

    But, they're supposed to be in the system to make it more solvent for the rising cost of care for boomers and seniors. And by the way, regressive payroll taxes just went up to subsidize that same group.
    America is eating its young.

    •  they will be heavily subsidized (3+ / 0-)
      Recommended by:
      tb mare, paytheline, v2aggie2

      if they can't afford the coverage.

      And the insurance itself is a huge benefit - preventing some horrific situations that young people all over this country have been in not having insurance.

      I'm sure there will be many who haven't done the math and don't understand what insurance is who will not like it, but this will be a major gain for this generation. It'll be the first time they, like their grandparents, are guaranteed access to medical care.

      How that means their grandparents are "robbing" them I can't even begin to understand.

      •  It won't be hard to understand (0+ / 0-)

        for a person who has to pay for insurance but still can't afford much health care due to co-pays and deductibles. I will be happily surprised if there are affordable plans that don't fit involve significant out-of-pocket expenses.

        •  One of the biggest obstacles lower income (1+ / 0-)
          Recommended by:
          tb mare

          people face in this country is budgetary shock. Because they are under-insured (medical, car, rental, home, etc) they are far more vulnerable to huge, unexpected expenses.

          Over time these shocks are what keep many people from climbing out of poverty. If it takes you two years to save up $1000 to get into a better apartment, for example, and you don't have health insurance, it only takes one moderate doctor-involved episode to wipe out all those savings. And over the course of two years, there's a good chance that will happen.

          Paying a co-pay or deductible instead of the whole bill would substantially reduce that shock.

          Then there's the idea that because they have health insurance, they'll go to the doctor when they come down with pneumonia, instead of dying in the gutter.

          •  Mostly (0+ / 0-)

            people don't either pay the whole bill or die in the gutter. They just suffer with the flu, maybe take a day off work and buy some over the counter medication. I don't see how that changes since it will still likely be cheaper than co-pays and a prescription.

            It will be beneficial for those who have a major illness, assuming they care about paying their hospital bill, which a lot of people don't do anyway. Apart from that, it will be very difficult to convince people that this works for them, and frankly, it isn't designed to. Young people are being forced into the system to make it more solvent for others. We all know that.

            •  Tell that to a young person (0+ / 0-)

              Who gets into a car accident.

              And how exactly does a low income person whose premium s 90% subsidized "shore up the system?" The people shoring up the system are the wealthy, who have a new tax, and people under 65 who are not being heavily subsidized. In other words, people who can afford to pay.

      •  It's also not hard to understand (0+ / 0-)

        that when people politely say that young people will make the system solvent, that it means they'll be paying much more into the system than they get out of it. Combined with Social Security and Medicare, that will make up most of the regressive tax burden on the young working class, who also face higher unemployment rates and unprecedented student loan debt.

        •  Do you have any statistics on employment rates for (0+ / 0-)

          under-30's compared to over-50's.

          I would love to find some.  Frankly, I would fully expect both groups to be on par with one another.

          And I certainly would expect that both these groups' unemployment rates would exceed those of folks ages 31-49.

          Mr. Mollie's company has been shedding folks over age 50 for more than a decade--to save health care costs.

          That's, I believe, one reason today that the UE rate has remained high for younger seniors (not yet retired, obviously).  Employers want to minimize their health costs.


          “If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

          by musiccitymollie on Fri Jan 11, 2013 at 04:11:01 PM PST

          [ Parent ]

          •  Google took me to AARP chart. (0+ / 0-)

            They show high unemployment for young workers, which is what I read elsewhere.


            •  Thank you, Willinois. Here's a couple of more (0+ / 0-)

              news articles that mention high unemployment among young college graduates and individuals over age 45.

              Here's a link to "Unemployment for college graduates and people over 45 hit highs."

              And this AARP article entitled, "Unemployment Over 55 Is Worse Than The US Average."

              It's a shame that "jobs" have not been given a higher priority.  We could do a lot toward lowering the deficit, if we could get folks back to work.


              “If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

              by musiccitymollie on Fri Jan 11, 2013 at 10:18:27 PM PST

              [ Parent ]

        •  Social security is quite solvent (0+ / 0-)

          You just outed yourself as some kind of libertarian. Have a nice day, Ron.

      •  But are subsidies retroactive only? (0+ / 0-)

        My understanding is that you will have to pay the full outrageously high premium out of your own pocket, and then when you file your taxes 15 months later, you will get a rebate of a lot of that cost. If that's the case, there are going to be a lot of people who qualify for the subsidized plan, but can't loan the government the money for a year in the hopes that Congress will appropriate enough to reimburse them.

        •  I had no idea it would be like that. That is not (0+ / 0-)

          good....I thought people who couldn't afford it would just not have to pay.

        •  That's my understanding, too, rugbymom. (0+ / 0-)

          Which is one reason that the exchange did not go into effect until 2014.

          Here's an excerpt from the Kaiser Family Foundation regarding the passing and the implementation of the Medicare Program:


          1965: President Johnson signed H.R. 6675 to establish Medicare for the elderly in Missouri. President Truman was the first to enroll in Medicare.

          January 1965: President Johnson's first legislative message to the 89th Congress, Advancing the Nation's Health, detailed a program including hospital insurance for the aged under Social Security and health care for needy children.

          March-July 1965: The House of Representatives (307-116) and the Senate (70-24) passed "the Mills Bill" (H.R. 6675), a package of health benefits and Social Security improvements.

          July 30, 1965: President Johnson signed H.R. 6675 (Public Law 89-97) to establish Medicare for the elderly and Medicaid for the indigent in Independence, Missouri, in the presence of Harry S. Truman who advocated for such legislation in a message to Congress in 1945.

          Presidential remarks during signing ceremony

          1965: President Truman was the first to enroll in Medicare.

          • Medicare Part A deductible: $40/year
          • Medicare Part B premium: $3/month

          1966: The Social Security Administration announced the selection of private insurance companies to perform the major administrative functions of bill processing and benefit payment functions for Part A (Hospital Insurance) and Part B (Supplementary Medical Insurance) of the Medicare program.

          July 1, 1966: Medicare coverage began. All persons age 65 and over were automatically covered under Part A. Coverage began for seniors who signed up for the voluntary medical insurance program (Part B). More than 19 million individuals ages 65 and older were enrolled in Medicare. . . .

          It's hard to imagine that during the pre-computer era of the 1960's, Medicare was up and running one year after it was signed into law, but it's taking 3 and 1/2 years to get the ACA fully implemented.

          The ACA was signed into law on June 25, 2010 (here's the link) but will not be fully implemented until January 2014.

          But, the Medicare Program was a very real benefit, at a very low cost to the senior cohort that it serves.



          “If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

          by musiccitymollie on Fri Jan 11, 2013 at 04:56:56 PM PST

          [ Parent ]

      •  Exactly what does "heavily subsized" mean? I (0+ / 0-)

        believe that the amount for an individual is in the mid-$30,000 range (not a great deal of money, if you're self-supporting, and pay the rent or mortgage on one income).

        I looked into what the subsidy cutoff is for a couple, and it is shocking low, IMHO. It's $46,000 annual income.  That's skimpy where we live, and we're not in a major metropolitan area.  

        I believe that the exchanges and premiums MAY BE rated by region, but the actual qualifying income (in the case of a couple) is not.

        So, I'll leave that it to you couples in NYC, San Francisco, Chicago, Atlanta, Houston, Portland, Seattle, etc., to answer--could you live off that as a couple, and still afford several hundred dollars for a health insurance premium?


        “If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

        by musiccitymollie on Fri Jan 11, 2013 at 04:24:05 PM PST

        [ Parent ]

    •  I agree with you Willinois, but I would expand (1+ / 0-)
      Recommended by:

      your statement to include many older folks, who make too much to qualify for a subsidy, but won't be able to eat and pay hundreds of dollars a month extra for a health insurance premium.

      Remember, the insurance companies may charge seniors up to 3 times more than young people.  

      Therefore, this group will be one of the hardest hit age cohorts--folks over 50 who obviously don't qualify for Medicare, but may no longer be in the workforce, and are age-rated under the exchange.


      “If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

      by musiccitymollie on Fri Jan 11, 2013 at 04:04:40 PM PST

      [ Parent ]

  •  Is there any reason why HHS (0+ / 0-)

    (or, a private non-profit) couldn't set up a website to act as a clearinghouse for each of the exchanges, whether a state exchange or a Federal exchange?  That would strike me as a first step -- to be followed by a public information drive to let people know.

  •  States should be able to find willing help from (0+ / 0-)

    hospitals now caring for uninsured folks in their ERs and clinics,  I worked for a catholic hospital in downtown Paterson, NJ when CHIP was rolling out (I managed the Family Health Center outpatient primary and specialty clinics) and we hired a competent high school student at minimum wage to call the families in our care and invite and schedule them to come in.  She helped them complete their applications (after some training from our Case Managers and with their oversight).  It was a great success: 1) we now were going to be better reimbursed for our services; 2) many families now had insurance; 3) that young high school woman had a good exposure to real life work in her community.

  •  No shit. (0+ / 0-)
    “The uninsured population is an extremely difficult population to reach,” said Michael Marchand, director of communications for the Washington State Health Benefit Exchange. “They’re uninsured for a reason."
    You have to wonder if that reason was good enough to force me into having to cut back on the "Cadillac" health plan I currently offer my employees of if I can't pay the surcharge - in effect, punishment for offering more than most.  

    It sucks.  

    Intolerance betrays want of faith in one's cause. - Gandhi

    by SpamNunn on Fri Jan 11, 2013 at 02:31:30 PM PST

  •  Alaska fits that sabotage criteria. And so many (0+ / 0-)

    folks need this--like yesterday.

  •  Misunderstanding of who's uninsured? (0+ / 0-)

    The low income / homeless / etc. folks are already on Medicaid (or Medicare for disability, or both). Undocumented immigrants, as I understand it, aren't eligible for anything. The people who really need the exchanges are the middle tier, too much income to qualify for Medicaid, too little to afford premiums, or work for an employer who doesn't provide it. Many of those folks are quite capable of reading and responding to ads, and what they need is an easy access point (that doesn't require taking a day off from work).

    The other key is the people like me and another comment here: My employer offers coverage, but the cost (for adjunct faculty) is far above the 8% or whatever threshold. I still haven't been able to figure out if I can opt out of that and buy through the exchange instead, or if I'm stuck with what my employer offers or else the penalty.

    So it's not just advertising that says "hey, this exists." It's having a really good, easy to understand, easy to navigate, and accurate website and phone line full of FAQs and worksheets and staffers who know what they're talking about. Given how complex the exchange system is, and the general tendency of states to contract this sort of thing out to the lowest bidder and/or understaff it and rely on automated help lines, I'm not optimistic.

    Please can we move directly to single payer, like NOW?

  •  Point of contact with medical system (0+ / 0-)

    Hospitals, doctors, pharmacies, drug companies, medical device companies, chiropractors, etc. all have a vested interest in everyone getting insured.  Use them.

    The difficulty lies not so much in developing new ideas as in escaping from old ones! - John Maynard Keynes

    by Do Something on Fri Jan 11, 2013 at 02:47:11 PM PST

  •  Maybe small businesses could go to Wal-Mart (0+ / 0-)

    That's scary.

    Dateline Jan 11, 2013, 4:43pm EST

    Wal-Mart is exploring the idea of building a private health insurance exchange tailored to offer cheaper health insurance to small businesses, a vice president told Orlando Business Journal Jan. 11.

    Marcus Osborne, vice president of health and wellness payer relations for Wal-Mart Stores Inc. (NYSE:WMT), spoke to OBJ after his keynote speech at the Foundation of Associated Industries of Florida’s 2013 Health Care Affordability Summit. Osborne said Wal-Mart wants to work with insurers and managed care companies to find new, low-cost health insurance options tailored for small companies, which historically have limited options.

    Others have simply gotten old. I prefer to think I've been tempered by time.

    by Just Bob on Fri Jan 11, 2013 at 02:47:56 PM PST

  •  I got good news on ACA enforcement today. (0+ / 0-)

    Today I processed the first payroll of our fiscal year for my manufacturing company. As a small employer (who has been providing high quality health insurance to our employees for many years) I received the news today that since we have fewer than 250 employees we will not have to report the percentage of our employees' health insurance which we pay for them on their federal payroll reports and check stubs. Translation: they will not be taxed for it. YIPPIE!!! The IRS just released this revision three weeks ago, so it is new and the news will probably not have fully filtered out yet. The IRS continues to provide additional clarification both to employers and employees on ACA implementation as deadlines draw near. As best I can tell, they have all been reasonable and acceptable. As a small employer who welcomed the ACA with open arms, I look forward to the conclusion of the transition period and the final settling in of full implementation.

    "When in doubt, do the brave thing." - Jan Smuts

    by bunnygirl60 on Fri Jan 11, 2013 at 03:00:39 PM PST

  •  how about mandatory paycheck inserts? (0+ / 0-)
    population of uninsured is that many are the working poor
    it could include a statement about an employer's obligation to provide health care as well as exchange information.
  •  Proposal: Get Employers to do it (0+ / 0-)

    If Employers don't provide insurance than they should be required to provide their new employees with all the information they need to get signed up with the exchanges.

  •  This task seems ideally suited to the (0+ / 0-)

    folks from the Obama 2012 campaign team.  Their ability to microtarget was impressive.  

    Alternative rock with something to say:

    by khyber900 on Fri Jan 11, 2013 at 04:07:22 PM PST

  •  My head is spinning (0+ / 0-)

    after reading these comments, because every statement and every statement debunking the previous statement are all things that I've heard too.  And we have all had skin in this game since before Obama was elected the first time....trying to get universal health care, debating among ourselves which way we wanted it to go, how it should work, and probably accepting with some disappointment that this is what we ended up with....this has been going on forever it seems.  And if *we still don't know simple it a monthly premium or do we file to get it back at the end of the year....will there be a $10,000 deductible before it kicks in, are the people who post comments on local news sites who don't have insurance because they can't afford it but don't want the president who wasn't even born in this country to take the guns that they don't even own or tell them that they have to participate in Obamacare ever going to understand that this is supposed to be a good thing, when *we still don't really know?

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