politics surrounding Affordable Health Care Act Implementation

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Obamacare enrollment efforts, and message wars, heat up

http://www.mcclatchydc.com/2013/07/25/197655/obamacare-enrollment-efforts-and.html

WASHINGTON — Amid a resurgent effort by critics to attack the new health care law, the Obama administration and its allies are focusing on getting millions of Americans enrolled in coverage next year and making sure the new state health insurance exchanges will be ready for open enrollment in October.

But convincing a skeptical public to heed the Affordable Care Act's "individual mandate" will be a major challenge when the bulk of the health care overhaul is fully implemented next year.

Polls show that not only do most Americans dislike the provision that requires them to get health coverage or pay a fine for noncompliance, but they're also confused about what coverage they should get, how to get it and how much it will cost.

To better inform people of their options, nearly 1,200 community health centers will use $150 million in federal grants to help spread the word. Florida Community Health Centers, for instance, which operates 10 facilities in central Florida, will use its $173,000 grant to hire three full-time benefit counselors and an outreach worker who'll seek out the uninsured for coverage .

"We go to beauty shops, barbershops, day cares, laundromats, churches and any other houses of worship. That's where people congregate," said Molly Ferguson, the centers' director of program development.

These and other federal grants will help with outreach efforts, but congressional Republicans' refusal to provide more money for a public awareness campaign has made the enrollment effort more difficult. The health care law was passed in 2010 without Republican support.

Private Obama-friendly organizations such as Enroll America, Young Invincibles and Organizing for America will be counted on to help the administration try to win the health law messaging war. But opponents of the law have been on the offensive.

A recent analysis by Kantar Media, which tracks political spending, found that critics of the Affordable Care Act have spent $400 million on television ads since the law passed, compared with just $75 million by Obamacare supporters.

A $1 million anti-Obamacare ad campaign by Americans for Prosperity, a conservative political group funded by billionaire Kansas industrialists Charles and David Koch, is airing online and on cable networks in Ohio and Virginia.

"We feel it is important to educate Ohioans on the true consequences of government intrusion into the private health care decisions of families," said Eli Miller, the Ohio director of Americans for Prosperity.

The conservative Citizens' Council for Health Freedom has launched a national "Refuse to Enroll" campaign that urges people not to buy coverage through the exchanges.

The council, which describes itself as a "free-market resource" for health care issues, says the cost of coverage on the exchanges might be unaffordable for many, even with premium subsidies. The group claims, among other reasons, that the exchanges will offer only limited choices of physicians and hospitals and that they require considerable paperwork to enroll. It likens them to "Medicaid for the middle class."

"We encourage Americans to get involved and make sure that the exchanges fail and, as a result, Obamacare also fails," said Twila Brase, the group's president and co-founder.

In response, the left-leaning Americans United for Change will launch a "Hands Off Obamacare" ad campaign on cable news stations beginning next week.

In the face of dwindling funds and a powerful negative messaging machine, the Obama administration and a variety of public and private stakeholders will try to enroll an estimated 7 million people for coverage on the exchanges from October to March.

"We know it won't be easy," Health and Human Services Secretary Kathleen Sebelius said recently. "So many Americans have spent their whole lives being frustrated, gouged or turned away by our health care system, and connecting them with information they need to finally get quality affordable coverage is a huge undertaking. But the challenge of enrollment pales in comparison to the benefit that millions of American families stand to gain. And that's why we're doing it."

President Barack Obama, who's faced criticism for failing to personally embrace and sell his signature piece of legislation, took a decidedly stronger tone earlier this month, when he announced that 8.5 million Americans had begun receiving average rebates of $100 apiece, due to a provision in the law that penalizes wasteful spending by insurers.

"Our broken health care system threatened the hopes and the dreams of families and businesses across the country who feared that one illness or one accident could cost them everything they'd spent a lifetime building," he said. "And step by step, we're fixing that system."

Sebelius said the health center grants would pay for nearly 3,000 outreach workers who'd help an estimated 3.7 million people sign up for coverage.

Florida Community Health Centers hopes to assist 3,000 people a year through its grant, and Ferguson expects about 2,500 of them to be eligible for services through the health care law. Word-of-mouth may be the group's most effective recruiter.

"If you get one family (enrolled), you can be sure everybody in their neighborhood will know about it before the end of the day," she said. "Our patients are our best advertisement. They tell the story better than anybody."

HHS also has awarded $32 million to 41 state agencies, health centers and nonprofit groups in 22 states to help enroll eligible children for coverage in Medicaid and the Children's Health Insurance Program.

California Coverage & Health Initiatives, a statewide community and children's health outreach and enrollment network, received a $751,000 grant to enroll uninsured Latino children in the state's Central Valley and Inland Empire regions, where many Medicaid-eligible Latino children don't have coverage. It's a long-standing problem with many causes, including a lack of state resources to address the problem and a reluctance by Latinos of varying immigration statuses to seek government benefits.

"We see this persistent problem of families not aware that their children are eligible for coverage," said Suzie Shupe, the network's executive director. "So while our organizations have worked hard to (enroll them), it has been challenging."

The group hopes the grant will help enroll 6,000 to 10,000 Latinos in some level of coverage.

"All of the media campaigns and outreach and education campaigns that are going on with the coming open enrollment is a great opportunity to really educate Californians about coverage that's available and to get to those families that we haven't reached before," Shupe said.

Next month, HHS will award grants to "navigators," the individuals and organizations that will educate the public about the exchanges, provide impartial information about available health plans and explain the premium tax credits that will help individuals purchase coverage.

But the navigator programs will be grossly underfunded in states where the federal government will run the insurance exchanges, because Congress has refused to allocate more money. Just $54 million will go to those 34 states to assist millions of people who often don't know about the new laws, have never had health insurance and are unfamiliar with how to purchase it.

States with the most uninsured residents will get the bulk of the money, but 13 states will receive only the minimum $600,000 grants.

When Sebelius sought contributions from businesses to help fund outreach efforts by the private nonprofit group Enroll America, congressional Republicans launched an investigation, accusing her of violating the appropriations clause of the Constitution.

At a recent discussion about the Affordable Care Act at the National Press Club in Washington, Earl Pomeroy, a former North Dakota Democratic congressman and state insurance commissioner, said the GOP tactics were par for the course.

"Politics again is weighing in on this," he said. "I think a cynic could say you've taken efforts at voter suppression and we've moved them right over to efforts at enrollment suppression. . . . This is really about trying to, first of all, discourage the contributor universe and discourage any administrative efforts to raise privately what they could not get funded publicly, to the end that we don't really want people to know about these exchanges."

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Potential Donors to Enroll America Grow Skittish

http://www.nytimes.com/2013/05/20/us/politics/potential-donors-to-enroll-america-grow-skittish.html

WASHINGTON — The Obama administration's efforts to raise private money to carry out the president's health care law have provoked such a strong partisan uproar that potential donors have become skittish about contributing, according to several people involved in the fund-raising program.

Kathleen Sebelius, the secretary of health and human services, solicited donations.

White House officials said they did not sign off on the fund-raising calls made by Kathleen Sebelius, the secretary of health and human services, but were generally aware that she would be seeking support from outside groups.

Two House committees have begun investigating the solicitations. Five senior Republicans from the Senate and the House have asked the comptroller general of the United States, Gene L. Dodaro, to investigate the actions of Ms. Sebelius to determine if she was improperly circumventing spending limits imposed by Congress.

One of the House panels, the Energy and Commerce Committee, has also asked health insurance companies to provide records of any contacts with administration officials seeking money or other assistance for President Obama's campaign to enroll people eligible for subsidized insurance.

Reports emerged this month that Ms. Sebelius had urged business executives and nonprofit groups to assist Enroll America, a private nonprofit organization that will encourage millions of Americans to sign up for insurance this fall. Enroll America is led by veterans of the Obama White House and Mr. Obama's presidential campaigns and will use campaign-style techniques to locate the uninsured.

A federal health official said potential donors had become "gun-shy" because of the onslaught of Republican criticism of the administration's fund-raising practices. A person involved in raising money for Enroll America said that many corporations and philanthropies "are risk-averse and do not want to be involved in anything controversial."

The government is reviewing bids from insurers eager to sell their products to the public through marketplaces scheduled to open for business on Oct. 1. It is also weighing applications from community groups that want federal grants to serve as insurance counselors, or "navigators," who help people understand their coverage options.

Senator John Barrasso of Wyoming and Representative Jack Kingston of Georgia, both Republicans, said Ms. Sebelius appeared to be "shaking down" businesses and other potential donors. The House Democratic leader, Representative Nancy Pelosi of California, however, said Ms. Sebelius's efforts were entirely appropriate because "we have a responsibility to do outreach" to make sure people sign up for benefits to which they are entitled.

As evidence of the secretary's fund-raising prowess, administration officials said she had secured $10 million from the Robert Wood Johnson Foundation and a pledge of about $500,000 from H&R Block, the tax preparation service.

Brent Thompson, a spokesman for the Robert Wood Johnson Foundation, said, "We recently approved new funding for Enroll America." He refused to say how much, even though the foundation filed a report with the Foundation Center indicating that it had awarded a $10 million grant to Enroll America. The center collects data on philanthropy around the world.

Mr. Thompson declined to say whether the grant resulted from an appeal by Ms. Sebelius. He noted that the foundation had a "40-year history of supporting the expansion of coverage."

The foundation may have reason to be cautious. In 1993 and 1994, Republicans accused it of promoting President Bill Clinton's plan to remake the nation's health care system, and the chief executive of the foundation later said it had been "caught in the middle" of a highly partisan issue.

H&R Block plans to help low- and middle-income people apply for tax credits to pay insurance premiums under the new law. Obama administration officials said Ms. Sebelius had made a successful fund-raising pitch to the company, urging support for Enroll America.

But Gene King, a spokesman for H&R Block, said, "We have not made any decision to join any specific advocacy or other health care organization, nor reached agreement on any amount we would contribute to any specific group."

Several former administration officials are also trying to raise money for the rollout of the health care law.

Nancy-Ann DeParle, who stepped down in January as deputy chief of staff at the White House, said: "Since leaving the White House, I have contributed personally to Enroll America and asked others to support the organization's efforts. I have always thought it would be important for there to be a robust private sector education campaign to ensure that uninsured Americans know about the affordable health plans that will be available."

Ms. DeParle, who led the final negotiations with Congress on the health care law, said Enroll America was similar to private sector initiatives that helped people sign up for the Children's Health Insurance Program in 1998 and Medicare's prescription drug program in 2006.

Jason Young, a spokesman for Ms. Sebelius, said her activities were legal and had been approved by the general counsel and the top ethics officer at the Department of Health and Human Services. "A special section in the Public Health Service Act allows the secretary to support and to encourage others to support nonprofit organizations" working to improve public health, Mr. Young said.

Administration officials said the private fund-raising was necessary because Congress had refused to provide enough money to carry out the health care law. But Senator Lamar Alexander of Tennessee, the senior Republican on the Senate health committee, said the administration was "undercutting the Congressional power of the purse by circuitously exceeding the amount Congress has appropriated."

Federal officials knew that the solicitations might be controversial, Mr. Young said, so Ms. Sebelius did not make explicit fund-raising requests to companies or organizations regulated by her department.

Several former administration officials have sought financial support for the outreach campaign from insurers and other companies that stand to benefit from the law. But lobbyists said the response from several profit-making insurers had been tepid.

Jill Becher, a spokeswoman for WellPoint, one of the nation's largest insurers, declined to say whether the company had been solicited by current or former administration officials. "We are not planning to comment on this," Ms. Becher said.

Aetna and UnitedHealth also refused to comment. "I don't have anything at this point but will let you know if I do," said Donald H. Nathan, a senior vice president of UnitedHealth.

Matt Wiggin, a spokesman for Aetna, which received a Congressional demand for documents, said, "We will reserve any comment until we respond to Congress."