Obamacare starts in 100 days

June 23, 2013

For years now, Obamacare has been a bit of an abstraction, a law that would take effect in a few years–if the Supreme Court or a Republican president didn't intervene.

That ends now: Today marks 100 days until Oct. 1, millions can begin enrolling in the health care law's insurance expansion. That also means it's 100 days until the federal government must stand up health insurance marketplaces in dozens of states.


The Obama administration is making a different sort of sprint when it comes to Obamacare. (Antonin Thuillier/AFP/Getty Images)

This is the final sprint for the Obama administration and its allies. The White House has made a conscious decision to hold off on public outreach and education until right before open enrollment -- there's no point in pitching a product, the thinking has gone, until it's almost on the shelves.

There are, arguably, two big things that need to happen between now and October. The first is technical: The federal government needs to finish building the infrastructure that allows multiple government agencies to transmit information, determining whether an individual should qualify for tax subsidies. This is a really big lift that means connecting Health and Human Services, Treasury, Homeland Security and other agencies in a way that has never really happened before.

Also in the technical arena, the federal government needs to finish building the federal exchange, an online portal that most states will have their residents use to purchase health insurance. Fifteen states are also in the midst of putting finishing touches on the insurance markets they opted to run.

"It's a compressed time frame," says Kevin Walsh, a top executive at Xerox, who has worked extensively on Nevada's health insurance exchange. "We are working diligently to implement the entire scope of work for October 1. So, you back up from there. It means we have to have all our enhancements done in mid-July, so we can do the integration testing."

A few months ago, Walsh gave me one of my favorite charts on the health insurance exchanges, which explains why this technology piece is such a big lift for state and federal governments.


From outreach to eligibility determinations to bringing health plans into the marketplace, all of that needs to be ready by Oct. 1.

There's one other task on the Obama administration's plate just as big as technological work, and that's outreach. Even if the technological launch goes off without a hitch, that won't be much good if no shoppers show up to the marketplace.

To that end, non-profit Enroll America last week launched its education and enrollment campaign. The group started shortly after health reform became law. And their goal is, come October, making it impossible for an uninsured person not to know that there are new options available.

"If I'm uninsured and it's October, I won't be able to go anywhere without escaping a message," John Gilbert, who leads Enroll America's field operations, told supporters in a Thursday night presentation. "I turn on my TV and there's an ad. I go on the Internet and there's another ad. Someone shows up at my door to talk about it. I go to church and my pastor is talking about it."

Enroll America sees now through September as the time when they'll be gearing up for a big outreach push, doing education about new options that are coming but not necessarily urging the uninsured to take action.

There's lots of work to be done on this front: A Kaiser Family Foundation poll in April found that 42 percent of Americans didn't know whether the Affordable Care Act was law.


These are the technological and educational challenges that the Obama administration faces between now and October. It's got 100 days, starting right now, to fix them.

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Brad Plumer · June 23, 2013