Importantly, the success of Obamacare's first enrollment period — as told in interviews with Obama administration officials, advocacy groups, health care experts, and Obamacare shoppers—was not just about fixing a broken website. Healthcare.gov's disastrous rollout and ultimate repair mattered, but they didn't explain why people decided to buy insurance.The monthly surveys from Kaiser Family Foundation leading up to and throughout the enrollment period consistently showed that cost was a large factor for people and that large portions of the uninsured didn't have enough information about the law, specifically about the subsidies that were available to them to help get insurance. During those months of enrollment in late 2013 and early 2014, PerryUndem, a Democratic polling firm, was working with the White House and surveying the uninsured. They found the same thing—people wanted health insurance, but they weren't going to even shop for it because they couldn't afford it.
Behind the scenes, convincing Americans that they could afford insurance was the White House's biggest challenge in making Obamacare work.
"There's one woman we talked to, who I remember very clearly saying, ‘If you don't have money for shoes, you don't go shoe shopping,'" Undem says of the focus groups. "That's when we learned that 69 percent hadn't heard about financial help. If you don't know about financial help, and affordability is the number one concern, that's a huge problem."That was a far bigger barrier to people signing up than a glitchy website, it turns out. People who had already decided they were going to sign up weren't as deterred by the glitches, and might have grumbled about having the hassle of it all, but it didn't stop them whereas people who were convinced it was going to be too expensive didn't bother. These surveys were running during the enrollment period, giving the administration time to refocus their message. Which they did: "White House and pro-Obamacare groups did two things differently at the end of open enrollment, both aimed at increasing these numbers: they increased the number of events they hosted and overhauled their consumer message to make it all about financial help."
That—and the very human tendency to procrastinate—probably helps to account for the massive sign-ups at the very end of the enrollment period. But the cost factor, as Kliff says in this really very good article that you should read in its entirety, is going to be the primary story in the ongoing success or failure of the new law. Will the 8 million who signed up renew their plans next year, and will the good news about this year's success convince the 20 million still-uninsured to shop this fall? The administration—and Democrats—can't leave that to chance, and still has work to do to sell the law to these folks.