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Published: Sunday, September 29, 2013, 12:01 a.m.

Expect a slow start for Obamacare

  • People listen to an Affordable Care Act presentation by the Kansas insurance commissioner's office in Overland Park, Kan., on Sept. 17.

    John Hanna / Associated Press

    People listen to an Affordable Care Act presentation by the Kansas insurance commissioner's office in Overland Park, Kan., on Sept. 17.

WASHINGTON -- The White House is downplaying expectations for day one of the Affordable Care Act's insurance marketplaces, and it's not because of attacks from Republican opponents.
In recent weeks, senior administration members have begun predicting that there will be relatively few sign-ups on Tuesday, when tens of millions of Americans will, for the first time, be able to sign up for new insurance options. That means a date that has long been circled on health-policy calendars in the administration and across the country actually represents a "soft launch."
"October will be light for enrollment," White House Deputy Senior Adviser David Simas said. "Some people will sign up. November will be a little better. December, when people can sign up and know they get coverage in a week or two weeks, will be better than the previous month."
Such remarks may further embolden the health-care law's opponents in the House who on Saturday proposed delaying the program for one year as a condition of funding the government. The move all but guarantees the government will shut down at midnight Monday, just as the Affordable Care Act's marketplaces, known as exchanges, get ready to open for business Tuesday.
"Obamacare's not ready," Rep. Darrell Issa, R-Calif., said Saturday. "The delay is clearly essential. The president for eight months in a row has had at least one delay he's put into effect."
Most Americans, meanwhile, remain largely unaware of the health-care law's marketplaces, with polls showing many have no idea when enrollment begins -- or if the Affordable Care Act is even still law. Technical glitches have delayed some pieces of the marketplaces, meaning the first wave of shoppers will likely have the bumpiest experience.
That has some officials working on the health law cautioning against setting expectations too high for the health law's debut. The president, for example, often compares shopping for health coverage on the marketplaces to buying a plane ticket on Travelocity or Expedia.
The actual experience, according to those setting up the law in the states, is likely to be more complex and almost certainly will take longer than a few minutes.
"I think as a metaphor it's good since it anchors the idea of cost competition in people's minds," said Kevin Counihan, executive director of Health Access CT. "The reality is that picking a plane ticket is different than selecting a health plan."
White House officials say low enrollment in October would not reflect negatively on the law. They point to Massachusetts, which had an initially slow uptake rate but a big spike in November 2007, the month before a mandate to buy health insurance coverage took effect.
Officials who worked on the Massachusetts insurance expansion say that, in their experience, shoppers took an average of 18 separate encounters with the online marketplaces before purchasing coverage.
Under Obama's law, the requirement to carry health coverage does not take effect until January. Any insurance plans purchased this fall do not take effect until the start of 2014. Officials in Washington and across the country are skeptical that many people will buy a product in October that does not begin covering them until three months later.
"The idea that people are going to do layaway purchasing three months out goes against the American way," said Christine Ferguson, Rhode Island's exchange director.
Open enrollment lasts until the end of March, giving the uninsured a six-month period in which to purchase coverage.
"We are looking at Oct. 1 not as the beginning of a six-day or six-week push," Simas said. "This is six months of raising awareness, seeing what we can learn and applying that."
That will not stop opponents of the health-care law from pouncing on low enrollment numbers as evidence of the law's failure.
"If enrollment is low in the first month, it will tell you all the advertising and four years of preparation has not been enough to sell this scheme to the public," said Dean Clancy, vice president for policy at FreedomWorks, which opposes the health-care law. "If it's such a great deal, people would be lining up like it was the release of a new Apple product."
Lack of awareness may also prevent many from enrolling. A Kaiser Family Foundation poll published Saturday found just 12 percent of uninsured Americans know that new online marketplaces, known as exchanges, will launch Oct. 1. Three-quarters were not aware when the exchanges would launch, with the rest surveyed guessing an incorrect date.
Separate Kaiser Family Foundation polling this summer found that 44 percent of Americans were unsure whether the Affordable Care Act still stood. "They will focus on this soon enough," foundation President Drew Altman said. "There's no great imperative to focus on the law until it's real. I think enrollment will build slowly."
In California, which has more uninsured residents than any other state in the country, Covered California executive director Peter Lee joked that he expected exactly "two" people to sign up on Oct. 1.
"We really anticipate very few people going through the full enrollment process in the month of October," Lee says. "What we're pushing for is we want to have as many people sign up who will have their coverage become effective in January."

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