Only half the nation's governors have signed onto the Medicaid expansion under the Affordable Care Act and the bill's employer mandate has been delayed for a year, but the White House remains confident about its ability to make the state-based insurance exchanges that are a central part of the Obamacare roll-out a success.
In this, its optimism is reminiscent of that of the Obama reelection campaign during the late summer and fall of 2012, when the people running the microtargeting and ground operations expressed assurance about their efforts even in the face of polls that raised doubts about the president's prospects. That's not too surprising, as the White House team conducting the roll-out in conjunction with the Department of Health and Human Services involves pollster David Simas, the former director of opinion research for the president's reelection campaign and since earlier this year a top communications and strategy aide in the White House. He is now operating with similar Census-tract-by-Census-tract targeting care to figure out how to find and sell insurance to uninsured 18-to-35-year-olds who want coverage and are eligible for subsidies under the new law, which goes into effect on January 1.
The exchanges, or Health Insurance Marketplaces, are regulated, competitive regional markets that offer a range of plans that meet certain baseline standards, into which people will be funneled through a central website and application form. The key to getting them up and going is enrolling enough healthy people between 18 and 35 to make the risk pools work and keep rates competitive for the older, sicker people who will be drawn to the new insurance options. Insurers need young healthy people in the pool to keep rates lower for everyone; if only older, sicker people buy insurance at the outset, the calculus behind expanding health-care coverage through a private-sector market falls apart, because rates won't stay low enough for ACA subsidies to help low- to low-middle-income people afford insurance long term.