Next Challenge for the Health Law: Getting the Public to Buy In

But this focus group, along with nine others held around the country in November, was an important tool for advocates coming up with a campaign to educate Americans about the new health care law. The participants were among millions of uninsured people who stand to benefit from the law. With incomes below 400 percent of the poverty level, or $92,200 for a family of four this year, the focus group members will qualify for federal subsidies to help cover the cost of private insurance starting in 2014.

The sessions confirmed a daunting reality: Many of those the law is supposed to help have no idea what it could do for them. In the Miami focus group, a few participants knew only that they could face a fine if they did not buy coverage.

“It’s another forced bill,” said Christopher Pena, 24, who works in customer service.

There lies the challenge for Enroll America, a nonprofit group formed last year to get the word out to the uninsured and encourage them get coverage, providing help along the way. With the election over and the law almost certain to survive, the group is honing its fund-raising and testing strategies for persuading people to sign up for health insurance — a process that will begin in less than a year.

Starting next October, people will be able to shop for coverage, or find out if they are eligible for Medicaid, through online markets known as insurance exchanges.

“Our job is to convey to them that there is help coming that they didn’t know about,” said Rachel Klein, Enroll America’s executive director.

The group has raised only about $6 million so far — but financial backers include some major players in the medical industry: insurers like Aetna and Blue Cross Blue Shield, associations representing both brand name and generic drug manufacturers, hospitals and the Catholic Health Association. Insurance companies generally opposed the law before its passage in 2010 but now have a stake in its success.

Over the next two years, the group hopes to raise as much as $100 million for advertising, social media and other outreach efforts. “There are so many different groups that can play some role in this: hospitals, community health centers, pharmacies, tax preparers,” said Ron Pollack, chairman of Enroll America’s board. “Our job has got to be to try to galvanize each of those sectors, so there is a wide variety of ways people potentially can hear about this.”

Although the campaign will be national, the group will devote more resources to some states than to others. About half of the nation’s uninsured population lives in six states: California, Florida, Georgia, Illinois, New York and Texas. Of those, states whose leaders remain opposed to the health care law, like Texas, will probably get the most attention, Mr. Pollack said.

At the same time, Enroll America will coordinate with states, many of which are planning their own outreach and enrollment efforts, and with the Obama administration.

The Department of Health and Human Services has already awarded a $3.1 million contract to Weber Shandwick, a public relations firm, to plan a national education campaign for next year. It plans to seek proposals soon for a larger contract with a public relations firm that would help with the actual campaign, officials there said. Although the campaign has yet to take shape, an administration official confirmed that President Obama will play a role as it moves forward.

Republicans in Congress have already criticized the administration for spending taxpayer money to promote the law. Last month, Representative Dave Camp of Michigan, who leads the Ways and Means Committee, subpoenaed Kathleen Sebelius, the secretary of health and human services, seeking information on “public relations campaigns, advertisements, polling, message testing, and similar services.”

In addition to holding focus groups in Miami, Philadelphia, San Antonio and Columbus, Ohio, Enroll America commissioned a nationwide survey to help hone its message. The survey, conducted in September and October by Lake Research Partners, a Democratic polling group, found that the vast majority of uninsured people are unaware of the new coverage options provided by the law.

They are also skeptical. Many who participated in the focus groups or survey reported bad experiences trying to get health insurance, and doubted that the law would provide coverage that was both affordable and comprehensive.

“It’s two major mountains that need to be climbed,” Mr. Pollack said. “People are unaware of the benefits that could be provided to them, and they have to overcome skepticism, based on their past experiences with trying to obtain insurance.”

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