WASHINGTON -- Amid a resurgent effort by critics to attack the 2010 health care law, the Obama administration and its allies are focusing on getting millions of Americans enrolled in coverage next year and making sure the new state health insurance exchanges will be ready for open enrollment in October.
But convincing a skeptical public to heed the Affordable Care Act's "individual mandate" will be a major challenge when the bulk of the health care overhaul is fully implemented next year.
Polls show that not only do most Americans dislike the provision that requires them to get health coverage or pay a fine for noncompliance, but they're also confused about what coverage they should get, how to get it and how much it will cost.
To better inform people of their options, nearly 1,200 community health centers will use $150 million in federal grants to help spread the word. Florida Community Health Centers, for instance, which operates 10 facilities in central Florida, will use its $173,000 grant to hire three full-time benefit counselors and an outreach
worker who'll seek out the uninsured for coverage.
"We go to beauty shops, barbershops, day cares, laundromats, churches and any other houses of worship. That's where people congregate," said Molly Ferguson, the centers' director of program development.
These and other federal grants will help with outreach efforts, but congressional Republicans' refusal to provide more money for a public awareness campaign has made the enrollment effort more difficult. The health care law was passed without Republican support.
Private administration-friendly organizations such as Enroll America, Young Invincibles and Organizing for America will be counted on to help the administration try to win the health law messaging war. But opponents of the law have been on the offensive.
A recent analysis by Kantar Media, which tracks political spending, found that critics of the Affordable Care Act have spent $400 million on television ads since the law passed, compared with just $75 million by its supporters.
A $1 million ad campaign against the law by Americans for Prosperity, a conservative political group funded by billionaire Kansas industrialists Charles and David Koch, is airing online and on cable networks in Ohio and Virginia.
"We feel it is important to educate Ohioans on the true consequences of government intrusion into the private health care decisions of families," said Eli Miller, the Ohio director of Americans for Prosperity.
The conservative Citizens' Council for Health Freedom has launched a national "Refuse to Enroll" campaign that urges people not to buy coverage through the exchanges.
The council, which describes itself as a "free-market resource" for health care issues, says the cost of coverage on the exchanges might be unaffordable for many, even with premium subsidies. The group claims, among other reasons, that the exchanges will offer only limited choices of physicians and hospitals and that they require considerable paperwork to enroll. It likens them to "Medicaid for the middle class."
"We encourage Americans to get involved and make sure that the exchanges fail and, as a result, Obamacare also fails," said Twila Brase, the group's president and co-founder.
In response, the left-leaning Americans United for Change will launch a "Hands Off Obamacare" ad campaign on cable news stations beginning next week.
In the face of dwindling funds and a powerful negative messaging machine, the Obama administration and a variety of public and private stakeholders will try to enroll an estimated 7 million people for coverage on the exchanges from October to March.
"We know it won't be easy," Health and Human Services Secretary Kathleen Sebelius said recently. "So many Americans have spent their whole lives being frustrated, gouged or turned away by our health care system, and connecting them with information they need to finally get quality affordable coverage is a huge undertaking. But the challenge of enrollment pales in comparison to the benefit that millions of American families stand to gain. And that's why we're doing it."
President Barack Obama, who's faced criticism for failing to personally embrace and sell his signature piece of legislation, took a decidedly stronger tone earlier this month, when he announced that 8.5 million Americans had begun receiving average rebates of $100 apiece, due to a provision in the law that penalizes wasteful spending by insurers.
"Our broken health care system threatened the hopes and the dreams of families and businesses across the country who feared that one illness or one accident could cost them everything they'd spent a lifetime building," he said. "And step by step, we're fixing that system."
Sebelius said the health center grants would pay for nearly 3,000 outreach workers who'd help an estimated 3.7 million people sign up for coverage.
Florida Community Health Centers hopes to assist 3,000 people a year through its grant, and Ferguson expects about 2,500 of them to be eligible for services through the health care law. Word-of-mouth may be the group's most effective recruiter.
"If you get one family (enrolled), you can be sure everybody in their neighborhood will know about it before the end of the day," she said. "Our patients are our best advertisement. They tell the story better than anybody."
HHS also has awarded $32 million to 41 state agencies, health centers and nonprofit groups in 22 states to help enroll eligible children for coverage in Medicaid and the Children's Health Insurance Program.
California Coverage & Health Initiatives, a statewide community and children's health outreach and enrollment network, received a $751,000 grant to enroll uninsured Latino children in the state's Central Valley and Inland Empire regions, where many Medicaid-eligible Latino children don't have coverage. It's a long-standing problem with many causes, including a lack of state resources to address the problem and a reluctance by Latinos of varying immigration statuses to seek government benefits.
"We see this persistent problem of families not aware that their children are eligible for coverage," said Suzie Shupe, the network's executive director. "So while our organizations have worked hard to (enroll them), it has been challenging."
The group hopes the grant will help enroll 6,000 to 10,000 Latinos in some level of coverage.
"All of the media campaigns and outreach and education campaigns that are going on with the coming open enrollment is a great opportunity to really educate Californians about coverage that's available and to get to those families that we haven't reached before," Shupe said.
Next month, HHS will award grants to "navigators," the individuals and organizations that will educate the public about the exchanges, provide impartial information about available health plans and explain the premium tax credits that will help individuals purchase coverage.
But the navigator programs will be grossly underfunded in states where the federal government will run the insurance exchanges, because Congress has refused to allocate more money. Just $54 million will go to those 34 states to assist millions of people who often don't know about the new laws, have never had health insurance and are unfamiliar with how to purchase it.
States with the most uninsured residents will get the bulk of the money, but 13 states will receive only the minimum $600,000 grants.
When Sebelius sought contributions from businesses to help fund outreach efforts by the private nonprofit group Enroll America, congressional Republicans launched an investigation, accusing her of violating the appropriations clause of the Constitution.
At a recent discussion about the Affordable Care Act at the National Press Club in Washington, Earl Pomeroy, a former North Dakota Democratic congressman and state insurance commissioner, said the GOP tactics were par for the course.
"Politics again is weighing in on this," he said. "I think a cynic could say you've taken efforts at voter suppression and we've moved them right over to efforts at enrollment suppression. ... This is really about trying to, first of all, discourage the contributor universe and discourage any administrative efforts to raise privately what they could not get funded publicly, to the end that we don't really want people to know about these exchanges."