Obamacare Push Revs Up as Monday’s Insurance Sign-Up Deadline Looms

Media blitz and grassroots enrollment efforts focus especially on young people without insurance

The media blitz to sign up young people for health insurance is in a full final swing, with celebrity endorsements and pitches by top federal officials, ahead of Monday’s deadline to get enrolled or face a federal tax penalty.

President Obama recently plugged the health law on comedian Zach Galifianakis’s parody talk show “Between Two Ferns,” exchanging insults with the actor and scoring an online viral hit that brought thousands of referral clicks to the federal insurance marketplace, Healthcare.gov.

“Let’s get this out of the way,” Galifianakis says, after Obama mentions Healthcare.gov. “What did you come here to plug?”

The White House’s website features a March Madness-themed bracket listing of reasons to get insurance, with Facebook- and Twitter-shareable videos of Michelle Obama slam-dunking a basket held by Miami Heat star LeBron James, cats acting wacky, and college basketball coaches Geno Auriemma and Roy Williams pitching the Obamacare law.

Dozens of celebrities have been enlisted to draw the attention of the so-called “young invincibles,” uninsured people aged 18 to 34 who do not consider health insurance a priority, who in many cases are unaware of the March 31 deadline and the subsidies available to reduce the cost of enrolling.

Maroon 5’s Adam Levine has tweeted with the #getcovered tag, and his mom and the mothers of other celebs — including actors Jonah Hill and Jennifer Lopez, and singer Alicia Keys — appear in a video telling stories about their children and nagging viewers to sign up. Rosario Dawson, Eva Longoria, Pharrell Williams, Sarah Silverman, Mindy Kaling and many others have also put messages about the law in their Twitter feeds.

“We’ve had people ranging from like Fran Drescher to T.I., Janelle Monae — I think even her mother finally got covered, which I thought was pretty cool,” said Alescia Teel, the New Jersey communications lead for Enroll America’s Get Covered America campaign.

“We’ve had some pretty interesting people, so I think that draws attention to the issue, especially with young people, because they kind of say, ‘Oh, here’s this person I recognize that’s in front of it,’” Teel said.

Enrolling young adults is a priority in part because they use less health care, which will balance out the costs of insuring older and sicker enrollees. A shortage of younger customers could, in theory, lead insurance companies to raise their premiums, making insurance less affordable across the board. In a worst-case scenario, that could cause a so-called “death spiral” of falling enrollment and rising costs.

Ray Hurd, the Northeast regional administrator for the Centers for Medicare & Medicaid Services, said in an interview Wednesday that young adults are a focus of enrollment efforts simply because so many of them are unaware of the importance of having health insurance.

“There’s a large population of uninsured out there and a lot of them happen to be the young and healthy. And part of that is just because they don’t think they need it,” said Hurd, who is based in Boston.

Of the 74,370 people who had selected a plan through New Jersey’s insurance marketplace through February, 23 percent were 18 to 34 years old, slightly lower than the national average, according to federal data.

Much of the promotion of the law has taken place at colleges, with U.S. Secretary of Health and Human Services Kathleen Sebelius visiting Montclair State University on Monday and highlighting the lower-cost health plans available to young people. She said a 27-year-old who earns $25,000 a year can receive subsidized insurance for as little as $114 per month, an amount she compared to the cost of cell phone or cable TV plans.

After the enrollment period ends, only people who had technological problems with Healthcare.gov or who experience a status change such as a divorce or job loss can enroll for 2014. Under the Affordable Care Act, people who do not sign up by Monday face a penalty of $95, or 1 percent of income, whichever is greater.

Touting Federal Subsidies

A key part of the sales pitch to young people is the federal tax subsidies, which substantially lower premiums for lower-income enrollees. Justice Ceserano, Enroll America’s New Jersey state director, said many people are still confused about or unaware of the financial assistance that’s available.

The organization is also advising young people that buying individual health plans allows them to freelance or pursue creative goals rather than take the first full-time job they can find with employer-sponsored insurance, Teel said.

Nationally, 40 percent of potential enrollees are young adults, and an enrollment share below that level could lead to modest premium hikes next year, according to a Kaiser Family Foundation analysis.

Sebelius said Monday that the ACA includes provisions to ensure the stability of the insurance market even if some insurers have a disproportionate share of enrollees with health problems.

“I’m confident that we’ll have enough enrollment and enough young people to have a balanced risk pool,” Sebelius said.

To keep premiums down through 2016, the ACA includes a temporary program called reinsurance, which pays insurers with sicker, higher-cost members. Another program called “risk corridors” takes fees from insurance companies with unexpectedly high earnings and transfers them to insurers with higher-than-expected healthcare costs.

Students at Montclair State and other four-year colleges are typically required to have health insurance, but community college students are not, and their campuses have been a focus of enrollment efforts. Teel said enrollment counselors have been at Union, Burlington, Middlesex, Passaic and other county colleges in recent days, giving out information and helping students and community members sign up.


The outreach events have succeeded in enrolling some young adults while missing others. At Camden County College on Wednesday, a day after enrollment counselors held an event at the school, 25-year-old computer systems student Joel Otero said he was unaware of the Monday deadline. When told about the financial penalty for remaining uninsured, he shrugged.

“I never knew you had to get it,” he said, as he sat in a lounge area waiting for a class to start.

Otero said he lives in Camden with his grandmother, who is disabled. He said he has heard about the Affordable Care Act on local television news but has never visited Healthcare.gov or considering buying insurance, in part because he thought it would cost too much.

“I just heard you sign up for it on the Internet or call,” he said. “I can’t afford it right now.”

He was also unaware of NJ Family Care, which under the state’s Medicaid expansion provides free or low-cost health insurance to eligible enrollees. A single individual who earns less than $15,857 can get free coverage; enrollment is continuous, extending beyond March 31.

Millions of people across the country are similarly under-informed about the health law, according to a Kaiser Family Foundation poll conducted in mid-March. Only four in 10 of the uninsured knew about the deadline and only 11 percent said they had been contacted about the law by phone, email, text message or a home visit. Half of those under 65 without coverage planned to remain uninsured.

Cindy Jay, chief marketing officer at the insurance cooperative Health Republic of New Jersey, noted that far fewer state residents have selected plans on the state’s individual marketplace than the 362,000 projected by the Rutgers Center for State Health Policy. Those holding back include both younger and older adults.

“A lot of them are people who have already had insurance and lost it for some reason,” she said. “The uninsured population hasn’t migrated to the marketplace in this state yet.”

At the same time, advocates argue that awareness of the law has been increasing due to the celebrity endorsements and the efforts of Enroll America, the New Jersey Hospital Association, insurers, and a number of other organizations. They have been buying advertising and sponsoring events at hospitals, train stations, housing authorities, town halls, libraries and dedicated enrollment centers, in addition to colleges.

Reaching the tipping point?

“What we’re seeing now is the tipping point, where the message really is getting out there,” said Maura Collingsru, health policy advocate for New Jersey Citizen Action. “There has been a tremendous momentum building for many months. Clearly here in New Jersey the most impactful thing and the most important thing has been the boots on the ground. This is really a hand-to-hand, mouth-to-mouth campaign.”

Health Republic staffers have been at the Secaucus Junction train station this week, handing out literature, bags, jump ropes and first-aid kits, and urging commuters to enroll. The insurer has ramped up its online advertising in the last two weeks, which should bring it to the attention of more young adults, but it is targeting potential customers of all ages, Jay said.

The nonprofit insurer is also trying to make contact with more Hispanic residents, who Jay said are not enrolling at expected rates, and will participate in a televised enrollment event Friday evening with the Telemundo network.

AmeriHealth of New Jersey has not specifically targeted young adults but has taken a “grassroots approach to educating the people of New Jersey of all ages about the impacts of healthcare reform,” spokeswoman Jill Roman said in an email.

AmeriHealth’s sales representatives have been traveling the state in red, white and blue company-branded Mini Cooper cars, visiting chambers of commerce, health clinics, adult day cares and other organizations to sign up customers, Roman said.

“We are reaching consumers in ways we never have before,” she said, citing a visit to a Korean community center in Bergen County, where a representative spoke to 400 people through a translator. “Our goal is to be a resource to people and let them know we are here to help. The response we have seen to our community outreach has been very positive.”

The third insurer on the individual marketplace, Horizon Blue Cross Blue Shield of New Jersey, is holding an “Insure-A-Thon” with extended hours for its call center and for its Moorestown service center from Friday through Monday. From noon to midnight on Friday, a mobile unit will be stationed at a Walgreen’s in West Long Branch. Horizon did not respond to a request for comment.

This week the Obama administration announced that some people who encountered technical problems on Healthcare.gov would be allowed to enroll in health insurance after March 31. Hurd said people who started the enrollment process and could not finish by Monday night will be allowed to complete it later and avoid the penalty.

He said Healthcare.gov and the phone line for signups have seen huge increases in volume, with 1.2 million visits to the website on Tuesday. Further increases are expected through the weekend, making it likely some people will not be able to complete their enrollment by March 31.

The enrollment period for 2015 will open Nov. 15.