Inside The Plan To Get More Young Americans To Enroll In Obamacare

“Women are the ones." Only a quarter of the people who signed up for Obamacare in 2013 were between ages 18 and 34. Now outreach efforts have shifted as deadlines loom.

WASHINGTON — Obamacare supporters are hoping the day after Valentine's Day will be the day young people in America show health insurers some love. And they're banking on women to make it happen.

Feb. 15 is "National Youth Enrollment Day," a nationwide series of concerts, rallies, and online campaigns aimed at convincing more young people to sign up for insurance under the Affordable Care Act. It's the latest and largest piece of an effort that borrows heavily from President Obama's reelection campaign, a plan that's been slowed by the difficult rollout of the Affordable Care Act's online portal.

The date is also the last day Americans need to sign up for health insurance in order to have it by March 1.

With the (English-language, at least) website working, that effort is ramped up to near full steam. Health care enrollment by younger Americans has not met administration targets so far — only 24% of enrollees before Jan. 1 were between ages 18 and 34, according to administration demographic data. (The administration projected 39% of the 7 million enrollees by March would be young Americans.)

But the White House believes the early results show enough young people have signed up for insurance to avoid the so-called "death spiral," where sick people (who can no longer be denied insurance under the law) drag up premium costs by enrolling in insurance plans while there are not enough healthy people paying into the pool to support them.

Efforts on the ground have evolved. Early goals of door-to-door canvassing efforts similar to the unprecedented voter contact campaign Obama relied on to get elected have been scrapped, replaced with what White House allies call "precinct-level" strategy of which National Enrollment Day is the biggest single moment so far.

Beneath it all is a lingering search for the answer to health reform's toughest question: How do you get young, healthy men to buy coverage?

"I don't think there is a magic bullet," Justin Nisly, a top spokesperson for Enroll America, a grassroots enrollment effort closely allied with the White House and led by Obama 2012 veterans, said when asked about signing up young, healthy men. "If there is we'd like to find it."

For now, the answer to that question is find more women. The key to expanding the young male registration numbers, according to Nisly, is to make sure women are talking about health care.

Enroll America's research shows the source men most trust when making health care decisions are the women in their lives.

"Mom's number one, then comes significant other or wife," Nisly said. "Everything we see in the data shows us women are the ones."

This is convenient truth for health care supporters. Getting young women excited about Obamacare is relatively easy.

"It hasn't been a hard sell," Nisly said. Provisions like the requirements that women be charged the same as men and insurers provide birth control with no co-pay have proved appealing to women.

The original recruitment plan envisioned by Enroll America and other White House allies was highly targeted: Using an army of grassroots workers, the groups planned to knock on individual doors to find the uninsured and educate them about their new health care options.

After relying on that method during the opening months of health care enrollment, the effort has been largely scrapped, those familiar with recruitment said, especially when it comes to young people. It proved harder to find the volunteers supporters needed for canvassing efforts than it did to find volunteers willing to work at events, organizers said, and canvassing for young people proved slower than expected. In its place now is a recruitment drive focused on finding young people where they gather and handing out information about the health care law.

In a prime example, late last year, activists targeted people waiting in line for Air Jordans.

But dropping door-to-door recruitment efforts for event-based enrollment drives doesn't mean dropping the idea of using Obama campaign tactics to recruit young people to the health care rolls. On the contrary, activists say, events like National Youth Enrollment Day show that they're doubling down on a strategy modeled after the president's successful efforts to boost youth turnout.

The lack of a working website was an early problem, especially for youth enrollment, supporters of Obamacare concede. But now that the website is largely functional, the White House says it's the perfect way to woo young enrollees.

"If you were going to market something to young people today, you would want something where young people can go check it out for themselves. This is how young people shop: They google," Tara McGuinness, the White House's top spokesperson on the Affordable Care Act, said in an interview. "We have a site that allows you to check things out side by side. It's designed to provide a fair amount of choice and flexibility and personal decision-making."

While the grassroots work is done by groups outside the administration, the White House plays a key role in facilitating the efforts through a weekly conference call run through the Office Of Public Engagement. Marlon Marshall, a top official at the OPE, said the White House coordinated effort to woo young enrollees brings together a huge number of disparate groups, including African-American Greek organizations on college campuses, grassroots groups working on the ground in poor communities and social-media focused online groups. Marshall, a veteran of Obama's 2012 campaign, helped spearhead a December Youth Summit at the White House that brought together youth organizers and, he said, helped create the Youth Enrollment Day effort.

"You know what I would highlight? A lot of the faith organizing that is happening in communities," he said. "That's where we find a lot of people but also young people in these cities across the country, specifically young African Americans."

On the campaign trail, the president's campaign team often used rallying dates to centralize organizing efforts and create a sense of imminent deadline to boost volunteer participation and raise interest. Feb. 15 is meant to serve the same purpose, and organizers talk about it in campaign-speak.

"There will be events in cities all across America that will combine youth organizing approach but also have an enrollment hook," said Aaron Smith, a co-founder of the health care enrollment group Young Invincibles. He's excited to see pent-up advertising plans and other efforts planned for October finally launch now that is functioning.

"This is crunch time, we all have to really focus over these next three months," he said.

Smith said that his group has proven the best way to get young people to sign up for Obamacare is through a focus on affordability messaging. Young people who don't know much about the Affordable Care Act expect insurance coverage to be very expensive, and Smith says showing them the available subsidies for lower-income enrollees (a demographic that includes a lot of young people, he said) tends to spur interest the most. Some of the pro-Obamacare ads that have drawn the most attention so far — Oregon's now-suspended Portlandia-style ads and Colorado's Brosurance spots — haven't had what Smith would call the ideal messaging.

At the national level at least, there are signs that affordability will be the lead message when targeting the young in the immediate future. In January, the Obama administration announced former NBA stars Magic Johnson and Alonzo Mourning would star in a series of recruitment PSAs aimed at the sports TV audience. Johnson's ad talks up available subsides and urges viewers to find out what assistance is available to them.

Health insurers, who are relying on the administration and its allies to help boost enrollment totals, are happy to see a renewed effort but according to one close observer of the industry aren't holding their breath when it comes to waiting for events like National Youth Enrollment Day to work.

"Pessimistically optimistic," the observer said when asked to summarize industry views of White House-led youth outreach efforts so far. "I'd be loathe put any sort of adjective around it. Any and all efforts are helpful."

The source said insurers don't expect the administration is out of the woods yet when it comes to bad Obamacare headlines, and that could steer the youth enrollment effort off track.

"Every time they are building a little bit of momentum they get blunted by a bad story or a bad dozen stories," the observer said. "It's like everyday is a Friday news dump."

Over at the White House, meanwhile, there's a sense the momentum is with the law's supporters. Officials tout a December study from the Kaiser Family Foundation finding that the so-called "death spiral" is off the table as evidence that youth enrollment has gone fairly well so far, even if it hasn't hit the targets set out by the White House at the outset of health care enrollment. New youth enrollees are just helping to make a good thing better, said McGuinness.

"I wouldn't say it's all gravy," she said of adding new youth enrollees. "We have to work every day to reach people. But, what we've taken off the table is the threat of what some people are calling 'the death spiral.' … In some ways the big building blocks happened and no one noticed."

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