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 "Mom, you know I can't afford it," the young black man protests,
as he sits down at a kitchen table next to a bespectacled woman with
a laptop computer linked to the U.S. federal enrollment website,
HealthCare.gov.
"But for the first time you can," she replies reassuringly. "You go
to the HealthCare.gov website, compare quality plans and you could
get help paying for it."
The government-sponsored television ad, which is airing on five
national cable-TV channels, including ABC Family and TVLand, is part
of an uphill battle to increase youth participation in President
Barack Obama's signature domestic policy achievement. Youth
participation in the program is a key factor in whether the program
succeeds or fails in its first year.
U.S. government data released this week show the demographic of
adults aged 18-34 rose only slightly by the end of January to 25
percent of total enrollment in private Obamacare plans.
That is well below the 38 percent that administration officials have
talked about achieving to give insurers a strong mix of healthier
members, whose premium payments help offset the cost of older,
sicker policyholders.
Several top insurers have expressed unease about the mix of
enrollment so far, and Republican opponents of the law see weak
youth participation as the start of a downward spiral that will put
the government on the hook for more spending to keep it alive.
The Obamacare marketing push has already been delayed repeatedly by
the botched rollout of HealthCare.gov in October, requiring the
administration to focus its efforts on fixing the website. Given
those delays, experts say the Obamacare marketplaces could have
trouble getting much above the 30 percent mark by the time
enrollment ends on March 31.
Obamacare's advocates from the White House to federal and state
agencies, health insurers, hospitals and grassroots nonprofit groups
are launching the final push on Saturday, with what they call
National Youth Enrollment Day.
"We're entering the sprint to the end," said Aaron Smith, executive
director of Young Invincibles, a nonprofit group that is
spearheading youth outreach.
The Centers for Medicare and Medicaid Services, the federal
government's lead Obamacare agency, allocated $52 million for paid
media in the first three months of 2014.
The campaign has already had help from singers Lady Gaga and John
Legend and actress Olivia Wilde. Focus is now on sports celebrities
including former professional basketball star Magic Johnson, who
appears in a promotion alongside this week's Olympic Games. CMS will
also run ads during the hugely popular college basketball playoffs
known as March Madness.
Administration officials say young adults are only one audience for
the effort. But the campaign is targeting 25 U.S. metropolitan areas
that are home to 5 million uninsured young adults, according to a
Reuters analysis of U.S. Census data.
"There's a variety of tactics," said Marlon Marshall, deputy
director of the White House Office of Public Engagement. "All of
those things add up to one big echo chamber. And that echo chamber
is going to grow."
Health insurers are expected to fork out millions more to advertise
their plans. Nonprofit groups Enroll America and the nonpartisan Ad
Council have a $30 million TV campaign with singing pets.
The campaign competes with counter-messaging from Republicans and
other Obamacare critics including Generation Opportunity. The young
conservatives group sought to discourage enrollment last year with
viral online videos picturing young men and women cornered in
intimate medical settings by a creepy Uncle Sam puppet. The group
says it is planning "a barrage of efforts," which it declined to
detail.
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CONCERN OVER PRICE HIKE
Obama's Patient Protection and Affordable Care Act barred
longstanding insurance market practices that imposed sharply higher
prices on people who were sick or older. That puts the onus on the
program to spread insurers' risks between policyholders who need
lots of medical attention and younger consumers who tend to be
healthy and cheaper to insure.
The concern is that the fewer young adults sign up, the higher
insurance costs may have to rise for 2015.
A Massachusetts health insurance marketplace, launched in 2007 under
former Republican Governor Mitt Romney and widely seen as the
prototype for the Obamacare exchanges, took nine months to breach
the 30 percent mark, according to an analysis by Jonathan Gruber, an
MIT professor and an architect of Obamacare and Massachusetts'
earlier reforms.
Gruber and other experts say reaching about 30 percent participation
is a more reasonable goal for Obamacare in 2015 than 2014 given its
challenges, including bitter partisan opposition, scant funding, and
a public that is largely misinformed about the law and the botched
HealthCare.gov launch.
"It's going to take two or three years minimum to do what
Massachusetts did," said Brian Haile, senior vice president for
health policy at Jackson Hewitt Tax Service Inc., a tax preparation
service that is promoting Obamacare enrollment.
Analysts at the nonpartisan Kaiser Family Foundation maintain that
even if youth enrollment remains unchanged at 25 percent, it would
add only 2.4 percent to 2015 premiums because the law compensates
insurers for unexpected losses.
Obamacare's allies cite some distinct advantages. For one thing,
their youth enrollment push is getting under way just as the
Internal Revenue Service distributes hundreds of billions of dollars
in tax refunds that could provide the cash for initial premium
payments, experts say.
The relatively low income rates for young adults are also expected
to make them some of the biggest recipients of government tax
credits and other subsidies to buy coverage. Census data show 27
percent of America's 18.4 million adults aged 19 to 34 have no
insurance, while mean earnings range as low as $15,800, versus
$46,000 for the overall population.
"By far, the biggest sweet spot is younger people. They are
absolutely eligible for the largest subsidies. Many of them though
are individuals who haven't had insurance before," said Peter Lee,
director of California's healthcare exchange.
Standing outside Madison Square Garden in New York on a bitter
February night, Steven Abramson had little luck attracting young
people with flyers that read "NEED Health Insurance?" to fans headed
to watch the New York Knicks take on the Portland Trail Blazers.
The few women who did stop to take the pamphlets couldn't speak
English.
"The generation of older people understand the need for health
insurance, but with younger people, we have to convince them to sign
up, even though it is the law," said Abramson, a volunteer with the
Obama group Organizing for Action.
(Additional reporting by Marina Lopes in New York and Patrick
Temple-West in Washington; editing by Michele Gershberg)
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