Obamacare Redux

Obamacare fires are flaring up all over — in Hill hearings, in scary headlines about big rate hikes and in closed-door meetings of nervous Democrats.

Barack Obama is pictured. | AP Photo

The White House response: We’ll get to that.

President Barack Obama’s messaging gurus and their allies say they will step on the gas before enrollment begins this fall, but the effort, they concede, is not in full swing.

Obama’s allies know the health care law needs a massive outreach effort, but Obamacare Round 2 is already starting to look a lot like Round 1, when Democrats roundly accused the White House of botching its appeal to the public, giving Republicans the upper hand on defining the law.

It’s a clear contrast with the immigration reform effort, where the rollout has been filled with business and advocacy groups praising the Gang of Eight bill and quickly knocking down any attacks. This week, there has been plenty of fodder for GOP critics of the health care law but mostly silence from the administration.

Part of that is because the White House team is in flux. Tara McGuinness, who just joined the White House to run the messaging of the law, told POLITICO that her shop is “ramping up on the health care communications and outreach.”

She pointed out that Democratic senators met with White House chief of staff Denis McDonough on Thursday, the first in a series of Hill meetings.

Meanwhile, the groups that will be responsible for on-the-ground work say they’re waiting.

Obama is leaning heavily on outside allies, and on Friday he asked Planned Parenthood to help sell the law with a pitch heavy on benefits to women, like contraceptive coverage and preventive care — the same targeted themes he stressed during his reelection campaign.

But Enroll America, the coalition of health care advocates, industry groups, and labor and civil rights organizations that’s planning a massive outreach effort, says it’s still planning to kick into full gear its “Get Covered America” campaign this summer — it’s not speeding up the timetable. Headed by Anne Filipic, the former deputy director of the White House Office of Public Engagement, the coalition is planning a campaign of online organizing, grass-roots outreach and paid advertising.

Organizing for Action has been planning its own outreach campaign for the summer, too, which is shaping up as a big test of the strength of its armies of volunteers. OFA officials didn’t respond to questions about whether they’ll speed up their plans.

Why wait? The answer, the law’s supporters say, is that if they do the outreach too early — and people are told they can sign up for Obamacare coverage with generous subsidies but there’s nowhere to go right now — they’ll just tune out.

But Democrats are worried now — about the messaging and the mechanics of the rollout.

“I’m concerned — because we did take substantial criticism for putting this plan in place — that it achieve its true purpose,” said Rep. Lloyd Doggett of Texas. “There’s so much work to do in such a short period of time.”

Other Democrats say the public is still confused about the law and they want to see more outreach and public education. Sen. Max Baucus, an author of the law, raised that concern in a recent hearing, arguing that if the administration doesn’t act, they’ll face a “huge train wreck coming down” — a comment that got serious attention from Republicans this week.

“I think there is a lot of confusion,” Rep. Diana DeGette of Colorado, a chief deputy whip for House Democrats and a vocal supporter of the law, told POLITICO. She’s not worried about Republican “hand-wringing” about all of the law’s potential problems, she said, “but what is of concern is that the October deadline … is rapidly approaching, and we need to make sure there is outreach happening.”

DeGette agreed that it may be too early to crank up the outreach machinery to full volume. Even though she’s planning town halls this summer to talk up the law and its benefits and said all members of Congress should do the same, “I think it would just cause more confusion if we did it right now because there’s no exchange for them to go to.”

But DeGette still says there’s an urgent need for more public education — at the right time.

She recalled a recent conversation where “a woman came up to me in Denver and said, ‘I’m a single mom, I make $40,000 a year. I don’t know how I’m going to get health insurance.’” When DeGette told her the Colorado health exchange would open on Oct. 1 and she might be eligible for coverage and subsidies, the woman reacted as if she’d never heard of Obamacare before: “She said, ‘I am? How do I get that information?’”

Other advocacy groups, like the National Council of La Raza and Young Invincibles, say they already have their own outreach efforts under way. “We certainly think it’s never too soon to start promoting the fact that big changes are coming,” said La Raza’s Jennifer Ng’andu.

Ron Pollack, executive director of Families USA, an advocacy group that’s leading the outreach effort, says the top priority should be for HHS to just keep working on the exchanges and the other infrastructure that will be needed for the October launch.

“I have every reason to be confident that the train is on track and will arrive at the station on time,” Pollack said. “Will there be any glitches? Of course, … and as problems emerge, as they do with every new program, they will be fixed.”

But as Democrats are realizing, those glitches gives the Republicans plenty of room to jump on every hint of a problem with Obamacare — and that’s exactly what they’ve been doing.

Senate Minority Leader Mitch McConnell had fun with Baucus’s “train wreck” comment by suggesting that Obama should give a speech warning about how terrible the law will be, and other Republicans have been circulating the “train wreck” quote all week.

And Republicans got new ammunition for their warnings that Obamacare will cause big health insurance premium hikes after CareFirst BlueCross BlueShield proposed a 25 percent rate hike for its coverage of individuals — and said it’s because of the law. Maryland officials have insisted, however, that those rates aren’t final and the state’s insurance commissioner can reject them — a point HHS Secretary Kathleen Sebelius also made to lawmakers on Thursday.

Chet Burrell, CareFirst’s president and CEO, says the nonprofit insurer will have to raise its rates that much because of the law’s requirement that everyone will have to be accepted for coverage next year, even if they have pre-existing conditions. He’s not opposed to that goal — he calls it a “very worthy public purpose” — but says it will make individual coverage more expensive.

Everyone who is in Maryland’s high-risk pool now — a program specifically designed to cover people with pre-existing conditions — will switch to regular private coverage, Burrell said, and health coverage for those people is five times as expensive as it is for everyone else with individual coverage.

“This isn’t some evil health insurance company plot,” Burrell said, but a “realistic” look at what happens when everyone with pre-existing conditions can get regular health coverage for the first time.

Advocates aren’t too worried about the danger that other insurers across the country could boost their rates in the same way. Pollack said CareFirst, which provides coverage to his group, already had a history of asking for big rate increases even before the law.

Jen Mishory of Young Invincibles, which is trying to get young adults to sign up for Obamacare, notes that those aren’t the actual rates most people would pay — most young adults would get subsidies that would hide a lot of the cost. And if other insurers in the health exchanges offer lower rates, “the consumers will be able to choose” based on those prices, she said.

But Burrell predicts that other insurers will ask for the same kinds of rate increases when they sell their individual plans in the health exchange, and he says the only reason other Maryland insurers haven’t been called out on it is that their filings with the state have been so confusing that it’s hard to tell what their actual increases will be.

Members of Congress, meanwhile, had a big headache on their hands after POLITICO reported on efforts to fix a part of the law that requires lawmakers and their staffs to get their coverage through the health exchanges instead of through the same federal employees health plan that covers other government workers.

The problem is that the provision — added to the law by Republican Sen. Chuck Grassley of Iowa — isn’t clear on how they’d get their employer contributions that pays for most of their premiums now through the Federal Employees Health Benefits Program. The measure was supposed to be a statement that Congress should be treated like everyone else, but if they don’t find a fix, they could end up paying the entire premium themselves — which is harsher than how others in the exchanges would be treated.

Now, Democratic leaders are fighting Republican charges — fueled by the POLITICO coverage — that they’re trying to get special treatment for Congress, but they insist they’re just trying to make sure that there’s a way to pay for the premiums and treat all staff members equally (some fall under the provision, some don’t). House Minority Leader Nancy Pelosi is pushing for an administrative fix that wouldn’t require new legislation.

There are various scenarios about how that could happen, but the focus is on preventing them from having to pay the full cost of insurance themselves — unlike other people who will be in the exchanges or who get covered on the job.

But the whole episode shows how lawmakers are now facing the consequences of the way the health care bill was passed — by taking the Senate bill and passing it in the House, without the chance to work out a final bill in a House-Senate conference committee that would have cleaned up the sloppy language.

“It’s, frankly, grossly inadequate,” DeGette said. “It’s one of those Senate specials where they put it into the bill to get votes and then it never went to conference, so it never got fixed.”

This article first appeared on POLITICO Pro at 5:17 p.m. on April 26, 2013.