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Obama may call it 'Obamacare,' but not people promoting it on the ground

ATLANTA -- “We never mention Obama,” says Riley Wells.

In Washington, talk of “Obamacare” is constant. Republicans created that term in 2009, looking both to heighten the political divide over the health care reform process and also because they argue the law’s official name, “The Patient Protection and Affordable Care Act,” inaccurately depicts a provision Republicans say will eventually increase health costs for millions of Americans. Democrats, including President Obama, accepted the moniker, at first with reluctance and now proudly.

But not outside of Washington. Many of the officials, most of whom are Democrats, who are trying to implement the Affordable Care Act are eager to avoid the term “Obamacare,” and all of its accumulated baggage. To them, one of the keys to the success of “Obamacare” is that it stops being “Obamacare” and turns into just another part of a broader health care system most Americans use without fully understanding.

So these officials, particularly in more politically conservative states, are selling “Obamacare” aggressively, just without the Obama part.

When Wells’ group, Enroll America, which is touting the law in Georgia and nine other states, comes to someone’s house, they talk about “new health care options,” “subsidies,” “marketplaces,” and other less politicized phrases. They often get blank stares and confused looks, but that’s better to them than the political opinions that might arise if “Obamacare” was invoked.

In Kentucky, the state’s government has rebranded “Obamacare” as “kynect” (“pronounced “connect”), the entity the state created to run its health insurance program under the law. (Its formal name is the Kentucky Health Benefit Exchange). Many in the state don’t know exactly what “kynect” is, but they know Obama, and only 38 percent of voters there backed him in last year’s election. “Your Health Idaho,” the “Obamacare” entity in that state, emphasizes on its website that it is “designed, driven and controlled by Idahoans.”

The officials are not disguising that they are trying to promote the new health care law. When they are directly asked by residents if they are involved with “Obamacare,” officials say yes. But they are not advertising the president’s role.

“We make it clear we are not going to argue the politics,” said Carrie Banahan, who is running “kynect” in Kentucky, “We don’t want to make it political.”

“We’re not doing this for exercise”

Enroll America is a national, privately-funded non-profit group designed to encourage Americans to sign up for health insurance plans under the law. (It has not released a full list of its donors, but has received money from the Robert Wood Johnson Foundation, and its board includes several representatives from hospital associations and health insurers). The group has hired staff in Georgia, Texas, and eight other states with large numbers of uninsured people. (Enroll America is not in Kentucky, which is operating “kynect” on its own, aided by federal funding that goes to state-based exchanges.)

Enroll is officially non-partisan, but its leaders have close ties to the Obama administration, and Secretary of Health and Human Services Kathleen Sebelius has been criticized by Republicans for calling organizations and urging them to donate to the group. Many on its staff worked on Obama’s 2008 and 2012 campaigns and are now heading out to states like Georgia, whose Republican governor Nathan Deal has refused to expand Medicaid or set up an online website (called an “exchange” in “Obamacare” parlance) to help people buy insurance under the law.

Wells, who worked on Obama’s 2012 campaign in Ohio, is the organizing director in Georgia for Enroll America, tasked with recruiting a team of volunteers to go door-to-door and hand out pamphlets that direct people to go online so they can explore options under the new health law. Enroll America has a full-time staff of seven in Georgia to reach residents in the state, where more than 19 percent of the people (about 1.8 million) are uninsured, one of the highest percentages in the country.

Aides who worked in the data team in Chicago on Obama’s 2012 campaign have joined Enroll America and have used similar modeling to produce a list of people in communities around the country who are uninsured. The volunteers and field staff in the ten states are planning to repeatedly contact the uninsured until they obtain health insurance, the same way the Obama campaign would pester people until they cast their ballots in last year’s presidential campaign.

So Wells is training the volunteers on campaign-style techniques, as many of them had no previous experience in door-to-door organizing.

“We’re not doing this for exercise,” Wells told the 12 volunteers in a meeting at an office park before they left to canvass on a Saturday afternoon earlier this month. “This is real stuff, this is really changing people’s lives.”

Then, the volunteers left to go to the neighborhoods to which they had been assigned, many of which were overwhelmingly black. When the volunteers knocked on doors, per Wells’ instructions, they stuck to a script, emphasizing new health care options, a website called “getcoveredamerica.org” where residents could get more information, and a text message code for people to receive updates on their cell phones.

When a woman asked if the health insurance was free, the volunteer said it was “heavily subsidized” and directed her to the website.

The adherence to the script was consistent and in one way surprising: even with African-Americans, among whom Obama is extremely popular, organizers believe using the phrase “Obamacare” is less useful than simply talking about the law and its potential benefits for them.

“But what if it doesn’t pass?”

But if health care officials aren’t eager to talk about the president’s role in the new law in black communities in Atlanta, that avoidance is even more logical in Kentucky, a red state politically but one where about 15 percent of residents (more than 600,000 people) don’t have insurance.

At the Kentucky Bourbon Festival in Bardstown, a small town about an hour outside of Louisville, state officials last week set up a tent and booth with a sky blue awning advertising “kynect: Kentucky’s Healthcare Connection.” (Kentucky’s Democratic governor, Steve Beshear, is a strong supporter of the law, and unlike Deal, authorized the creation of “kynect” to run Obamacare’s implementation in the state and staffed “kynect” with 25 full-time employees.)

The officials gave out pamphlets, most of which avoided the phrase “Affordable Care Act” and none of which mentioned the president’s name, but did provide estimated costs for coverage under the law. More importantly, they handed out sky blue “kynect” tote bags that showed a picture of the sun shining above a group of the commonwealth’s residents.

At the festival, which is more like a traditional fair with food and booths than a bourbon tasting event, the bags were popular, as people wanted to use them to hold candies and other things they bought. Some approached the “kynect” table just for the bags, but officials would not give them one until they heard a pitch about the new health insurance options.

In a state where Mitt Romney won by more than 22 points in 2012, there were no doubt some Republican voters walking around with their tote bag and effectively advertising the president’s health care plan to the thousands of people at the festival.

A few of them figured this out. One woman brought the bag back, saying “I don’t support this” and quickly shuffled away without explanation. Kentucky’s exchange officials said that had happened a few times when they handed out the bags at the state fair in August.

But in general, “kynect” officials are able to avoid the political debate on the law. Hundreds of people came to “the kynect” table at the festival, and spoke to a rotating group of half dozen officials who work for “kynect.” Most of the Kentucky residents spoke either of not having insurance personally or a relative who was uninsured, largely because of some kind of pre-existing condition. The staff explained that the new “options” would be available on a state-based website and that pre-existing conditions would no longer bar people from buying insurance.

Several people literally sighed in relief and smiled when they heard the pre-existing conditions line. They assured the “kynect” officials they would go online on Oct. 1.

The “kynect” staff never invoked the national debate over health care, and only a few people who approached their table did.

One elderly woman asked, “Is this Obamacare? ” The volunteer nodded in the affirmative. The woman then said she had heard from friends that people who sign up for Obamacare “get a chip inserted in their shoulder,” which she cast as akin to a government tracking device. She was assured this was not the case.

Another woman named Debbie Redmon, who said she was insured but looking for health coverage for one of her family members, approached the “kynect” booth with confusion as well.

Redmon: “What’s this?”

Exchange official: “This is Kentucky’s version of the Affordable Care Act.” (There is a pause of several seconds, as the woman looked confused.)

“Obamacare,” the exchange official reluctantly conceded.

Redmon: “But what if it doesn’t pass?”

Exchange official: “It already passed.”

“I read in the news all the time about this person supports it, this person opposes it, I didn’t know it was the law,” said Redmon, who said she voted for Obama and supports the health care law.

When not talking to potential enrollees, many of the staff members involved with exchanges are quite political and eager to use the term “Obamacare.” In Atlanta, the volunteers for Enroll America were strong Democrats, who in interviews said they wanted to support the law in part because it bears Obama’s name. They were progressive news junkies who spoke of Ezra Klein and Chris Hayes as if they were household names. The 12 volunteers looked like the coalition of voters who helped reelect the president; five were black, most were women.

In Kentucky, many of the people staffing the “kynect” booth were health care professionals who strongly support the goals of the law and like Obama in part because he pushed so hard for it.

“If someone says this is Obamacare, I say, ‘yes,’” said one of the officials at the “kynect” booth at the festival, who did not want to be quoted publicly. “I’m proud of it.”

“This beats Obamacare”

To its supporters, Obamacare is simply the latest step in the process of expanding insurance to Americans through government-operated programs like Medicare.

But the sly way that Obamacare is being promoted illustrates a key difference. Medicare is popular among members of both political parties. Its recipients are open about saying they receive it. People over 65 get a card that says “Medicare” that they can keep in their wallet.

The Kentuckians who enroll in “kynect” will likely get health care cards from Aetna, Humana, or whoever their insurer is. The health insurance in “kynect” may have been conceived, funded, and completely proscribed by “Obamacare,” but the government of Kentucky is unlikely to announce this to its residents. “kynect” could become a popular program in Kentucky while the state’s Republicans continue to blast Obama and “Obamacare.”

And at least one strong supporter of “Obamacare” seems fine with this as a potential outcome. A Huffington Post story in August depicted a man who visited a “kynect” booth at the state fair in Louisville. After having the health care options explained to him, he told an exchange official, “This beats Obamacare I hope.”

When health care exchange officials from around the country participated in a conference call with him, President Obama repeated this anecdote, praising the Kentucky officials for their success.

“Arkansas is a good example; Kentucky is another good example; Idaho, interesting example — these are states where I just got beat. I mean, I do not have a big constituency in these states,” Obama said in a question and answer session this week with former President Clinton at the Clinton Global Initiative. He added, “I’m losing by 20 percent in these states. But the governors were still able to say we’re going to set up our own state exchanges, their own marketplaces. And each state is just using their own name for it.”

“Which is fine,” he concluded. “Because I don’t have pride of authorship on this thing. I just want the thing to work.”