Two-thirds of Americans still don't really have much of an idea what Obamacare is about according to a new poll. In part, that's because the White House will only today launch its big marketing push on enrollment — now that Healthcare.gov is working. Meaning that the Obama administration has a very short period of time to climb a very big hill.
The poll, released by Gallup on Monday afternoon, indicates that only one-in-five Americans consider themselves "very" familiar with the health care law. Just over half say they're "somewhat" familiar with it — oddly, the exact same percentage that made that claim in August, before the Healthcare.gov disaster and the political debate over insurance policy cancellations.
Those twin setbacks forced the White House to postpone its official marketing push for enrollment, something it had hoped to do beginning in October — if the website could actually handle people visiting and signing up. Instead, Politico reports, it's only with the December 1 relaunch that the Obama administration feels comfortable pushing people to sign up. But moreover, the administration plans to use the enrollment period — which has a December 23 deadline to ensure January 1 coverage — to highlight the policy's other benefits, a political bulwark against Republican complaints.
On Wednesday, the White House and Democratic allies will focus on how Americans are paying less for preventative care under Obamacare. On Thursday, they’ll highlight that people with preexisting conditions can no longer be charged more or denied coverage. And on Friday, they’ll emphasize the slowing growth in health care costs.
The Gallup poll had much more specific bad news for President Obama on that point: The least informed Americans are those that he most needs to get engaged. Here's how familiarity with the law breaks down by various demographics (Gallup combined the "very" and "somewhat" categories from above to evaluate familiarity.)
Those who most need to be informed are young people, lower-income Americans, and Democrats — groups for which there is obviously substantial overlap. The young people are particularly problematic for Obamacare's success. In order for insurers to meet their financial goals for participation in the exchanges, they need a large number of young, healthy people paying premiums into the system. If young people don't know about the program, that's a problem.
So why don't they? There are four possible culprits. One is identified above; the administration's slow roll-out — which is it's own fault — has meant only limited awareness. Another is Republican opposition. Republicans have largely avoided outlining specifics of the policy, focusing instead on painting the policy with a broad — and broadly negative — brush.
But a report from the Columbia Journalism Review's Trudy Lieberman at Politico points to another culprit: the media.
Overall, the press was not very prescient, not just about the ACA’s looming tech problems, but also in informing readers and viewers about this admittedly complicated bill’s downstream consequences.
So when the law actually came into effect on Oct. 1, Americans were by and large not prepared — not for the website when it froze up and not for the millions of cancellation notices that went out to Americans in the individual insurance market. The news hit like a bomb — and the political impact hit that much harder for the Obama administration.
Lieberman outlines a number of causes. The press tends to be fixated on the political battles surrounding the health care policy (see above). Health policy is complex and often boring. Those with the expertise to talk about the policy to the press tended to be people that were representing one side or the other in the political fight, prepped with well-honed talking points about the issue.
But part of it was that the media, in Lieberman's estimation, wasn't paying very close attention to the possible points of failure. With the website failure and policy cancellations, she writes, "many journalists were realizing that the real story was not the stuff of far-right paranoia ... it was the law’s messy tradeoffs, its power to create new classes of winners and losers as it tried to bring insurance to more Americans."
There's certainly an element of hindsight at play in this analysis. For instance, it's hard to see how the press could have known about and reported on the incipient failure of Healthcare.gov when the administration itself was caught unaware and also shields specifics about performance from the public.
Lieberman's critique also makes obvious the fourth culprit in not being informed: the public itself. Take that first graph, above. That the lines are largely unchanged since August suggests a general disinterest in the topic. Below is a graph showing interest in the topic of Obamacare on Google over the last 12 months. The letters show various news articles on the topic; the blue line is how much search traffic it saw. Interest peaked in early October with the launch and failure of the website — and then dropped. And the needle on awareness barely moved.
Obama's goal over the next few weeks is to turn those numbers around. It would have been a daunting task if the administration had started in October. What it may take, as some have predicted, is the first threats of fees and coverage mandate to spur enrollment. Which certainly won't make the program that much more popular.