Inside the Obamacare resistance

August 1, 2013
resistance 2
Stephen Decker holds a mock Obamacare card as he and other members of Young Americans for Liberty take part in a training video with FreedomWorks for the "burn your Obamacare card" campaign. (Matt McClain/The Washington Post)

Dean Clancy wants you to burn your Obamacare draft card. That there’s no such thing as an Obamacare draft card is, at best, only a small problem.

Clancy is a vice president at FreedomWorks, where he has spent years fighting President Obama’s health-care law. But now, with a Supreme Court case and presidential election both lost, he and his allies are banking on a last-ditch campaign to undermine Obamacare: convince Americans to ignore it altogether.

FreedomWorks believes it has identified a core weakness of Obamacare: the young adults who are crucial to keeping premiums in the Affordable Care Act’s new coverage programs low, the same demographic the White House sees as crucial to the health law’s success.

Young adults tend to have lower medical bills, which would hold down premiums for the entire insurance market. If only the sick and elderly sign up, health costs would skyrocket. FreedomWorks wants to make that happen and, in so doing, doom the law.

“The whole scheme is enlisting young adults to overpay, so other people can have subsidies,” Clancy says. “That unfairness reminded us of the military draft.”

While the military has draft cards, the Affordable Care Act does not. Instead, FreedomWorks took an image of the Vietnam draft cards and grafted the word “Obamacare” to the top. The hope is that students will film themselves burning these cards and upload the videos online.

“We’re trying to make it socially acceptable to skip the exchange and pay the fine,” Clancy says. “Our goal is directly opposite that of the administration’s. Our mantra is, ‘skip the exchange, pay the fine.’”

Clancy concedes it's a difficult pitch. His group, and others, will ask Americans to forgo billions in tax subsidies that could, for many uninsured Americans, make health insurance affordable for the first time. But the anti-Obamacare movement has few options left.

“As it stands, we’ve got to wait three years for a certain president to be gone,” says Twila Brase, president of the Citizens Council for Healthcare Freedom, which opposes enrollment in health law programs. “It’s never going anywhere with President Obama. But this is something we can do right now.”

Brase has a flier, titled “Refuse to Enroll,” that she circulates among tea party groups.

“If you oppose Obamacare - as 49 percent of the public does - the Exchanges provide an opportunity,” the flier says. “If not enough people enroll, the Exchanges will fail. If the Exchanges fail, Obamacare fails. Defend your freedom by refusing to enroll.”

'An incredibly productive fight'

State activists have succeeded in blocking key health law programs. (Matt McClain/ The Washington Post)
State activists have succeeded in blocking key health law programs. (Matt McClain/ The Washington Post)

It’s easy to write off the Obamacare opposition movement as a failure. After three years, hundreds of rallies and millions spent in advertising, President Obama’s signature legislative accomplishment still stands. Experts roundly expect its major provisions, including the requirement to purchase health insurance, to take effect on Jan. 1, 2014. Some Republican legislators have already made plans to help constituents enroll in the health law programs.

But from Tim Phillips's perspective as the president of Americans for Prosperity, Obamacare resistance has been a stunning success.

"The day we lost in the Congress, if you had said we would be where we are today, with the Medicaid expansion and the exchange blocked in so many states, with the public’s attitude towards the law, with the employer mandate delayed, I don’t think we would have thought that it was possible,” Phillips told me over lunch at a Chinese restaurant, downstairs from his Arlington-based headquarters.

Twenty-one states have refused to expand the Medicaid program, which was meant to cover an estimated 17 million Americans who earn less than 138 percent of poverty (about $15,000 for an individual). Even more have refused to build the health insurance marketplace at the heart of the Affordable Care Act, putting a larger workload on the federal government.

The law remains just as unpopular as it was the day it passed, especially the requirement to purchase health coverage.

“That’s what I tell people when they ask, can we really turn this around,” Phillips continues. “Look at where we are now, versus the day it started in March. It’s been an incredibly productive fight from the outcomes basis. We’ve got to continue that."

Americans for Prosperity has spent at least $1.7 million over the past month on two television ad campaigns, where a mother and a doctor ask questions about what Obamacare means for them. The group has spent more advertising against the health law since President Obama signed it than they did during the legislative battle.

In the coming month, they plan to turn their attention to young adults. The White House has estimated that, of the 7 million people it expects to enroll in coverage this year, 2.7 million will need to be young adults.

Phillips is mulling setting up kiosks at Universal Fighting Championship matches and at college football games, where they’ll warn young men about the pitfalls of enrolling in Obamacare coverage. He hopes to give them some pause before enrolling.

“We want to make sure younger folks really understand the impact of this law as they’re being asked to sign up for it,” he says. “They’re the ones that the Obama administration wants to fund it with. It’s on their backs.”

'This is not private insurance'

FreedomWorks has designed Obamacare draft cards that it will encourage young adults to burn (Matt McClain / The Washington Post)
FreedomWorks has designed Obamacare draft cards that it will encourage young adults to burn (Matt McClain/The Washington Post)

Young adults are the age group that is least likely to carry health insurance. In 2011, the Census Bureau estimated that 27.2 percent of Americans between 18 and 34 lacked coverage.

Under Obamacare, 9 million young adults who currently lack health coverage will qualify for subsidized coverage through the exchanges, according to Young Invincibles, a nonprofit that supports the health law. Those subsidies significantly lower a young adult’s premiums: California officials, for example, estimate that a 21-year-old who earns $17,235 will be able to purchase coverage for as little as $5 per month.

Since it’s difficult to make an argument from self-interest against accepting free money to buy health insurance, anti-enrollment campaigns have pinned their hopes to framing the health law as a government handout – all financed by the young and the healthy. They’ll describe it as something akin to welfare or food stamps, and expect that middle-class Americans will then think twice about enrolling.

“This is not private insurance,” Brase, of Citizens Council for Health Care Freedom, says of the health plans that will be sold on the new marketplaces. “It is Medicaid for the middle class. The only way you get it is through an application to the federal government. Whether you pay the whole freight or get subsidized, you’re essentially buying Medicaid.”

Abigail Nobel is a tea party activist in Michigan, who will soon start a speaking tour across the state, urging locals not to sign up for coverage. She expects to rely on a similar message to dissuade people from enrolling, particularly in situations where a federal subsidy might make health coverage more affordable.

“As soon as you mention a government program and Medicaid, you don’t have to talk that long,” she says. “I like that there is still a stigma [around Medicaid]. That people want to stand on their own feet. When you need help, you should go to your neighbors and church. It’s the American way of doing charity.”

Americans for Prosperity’s Phillips says his message will focus more on reminding young Americans why the federal government wants them to sign up: To make health insurance more affordable for older Americans.

Whether the messages will resonate with young adults remains to be seen. Enroll America, the nonprofit leading enrollment efforts, has largely written off these campaigns as noise.

“Misinformation about the Affordable Care Act is nothing new,” spokeswoman Jessica Barba Brown says. “It’s been circulating since before it became law. What we’re finding now, is people are hungry for facts. We’re doing our best to explain what the reality of the law is.”

Health-care providers who work with the population, however, say that this message is the exact thing they worry about when it comes to getting patients to sign up.

“For a lack of a better way to say it, a lot of them have never been interested in taking any public services,” Maria Gomez, president of the health clinic Mary’s Center, says of her patients. “We’re going to have to say to them now, ‘You have this opportunity to come into the public system.’ They’re going to be like, ‘I don’t want to be part of the welfare system.’”

'I don't want anybody to burn their fingers'

Caitlin Grimes, center, hopes to stage an Obamacare card burning at her campus in West Virginia (Matt McClain / The Washington Post)
Caitlin Grimes (center) hopes to stage an Obamacare card burning at her campus in West Virginia (Matt McClain/The Washington Post)

Caitlin Grimes burned the first Obamacare draft card on a Wednesday afternoon in an Arlington parking lot.

“I’m burning my Obamacare card because Obamacare is turning full-time jobs into part-time jobs,” the 19-year-old college student from West Virginia said, as the mock government document smoldered.

“Do I just, like, throw it on the ground when I’m done?”

Grimes was among a half dozen conservative college activists, visiting Washington in late July for a Young Americans for Liberty convention, that FreedomWorks taped burning the mock draft cards. The footage will become an instructional video for other college activists who FreedomWorks hopes will participate.

The effort to burn Obamacare draft cards is decidedly milder than the Vietnam protests of the 1960s. For one, the cards are fake; Clancy decided early on his group would not encourage the burning of Internal Revenue Service forms that Americans will file next year to prove they purchased health coverage.

The video shoot took place in an out of the way parking lot, chosen as to not anger anyone. The Obamacare draft cards come with a set of verbal instructions.

“Light it on fire and while it’s burning say, ‘I’m burning my Obamacare draft card because, and then give a reason,’” Elizabeth Wheeler, FreedomWorks director of messaging, had instructed the group beforehand. “The shorter it can be the better. I’m not saying it can’t be long, but I don’t want anyone to burn their fingers.”

One by one, each student shared the reason they opposed Obamacare. The wind created a persistent problem; each Obamacare draft card took a few tries to catch on fire until one volunteer dug out a lighter from the restaurant Hooters out of his pocket.

“I’m burning my Obama card because I don’t think small business owners should pay double for the health care they got last year.”

“I’m burning my Obamacare card because I’m too busy paying student loans to pay for somebody else’s health insurance.”

“Amen,” Grimes calls out.

“I’m burning my Obamacare card because Obama care is killing small businesses.”

FreedomWorks will run a contest later this month to see which students can submit the best film of Obamacare draft cards burning. The winning group will receive an additional stipend to continue their activism on campus.

“Our hope,” Clancy says, “is that by being clever and nimble, using the Internet, earned media and a little bit of street theater, we can counter hundreds of millions of dollars being spent by the other side.”

Grimes is the state chair for Young Americans for Liberty in West Virginia and a student at Marshall College there. She expects to host a similar Obamacare card burning back on campus, so long as she doesn’t run into administrative trouble.

“It would be a really easy activism event,” she says, “if student activities doesn’t yell at us for burning things.”

But, Grimes reasons, “We’ve done dunk tanks and bonfires, so I don’t see why this should be a problem.”

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Brad Plumer | August 1, 2013