The success or failure of the healthcare law doesn’t hinge entirely on Oct. 1, which falls on a Tuesday when Congress will be in session. But it’s nevertheless a critical date in the implementation effort, and will mark the public's first real look at the centerpiece of a law that has dominated domestic politics for years.
The White House has two big tasks over the next month: Make sure the new marketplaces are ready for prime time; and get people interested in signing up for coverage.
The public-relations push will get a big jolt this week from former President Clinton, who is scheduled to give a speech Wednesday making the case for the new law.
Clinton’s reputation as “explainer in chief” could be a big asset as the Obama administration tackles a daunting education effort: A recent Kaiser Family Foundation poll found that 44 percent of those surveyed didn’t know whether the Affordable Care Act is still on the books.
The administration's enrollment efforts come as some conservatives in Congress are pushing for ObamaCare to be defunded.
The law is poorly understood as well as unpopular, and its supporters believe public opinion will turn around if and when people get a better handle on what the law does (and, just as importantly, what it doesn’t do).
In the short term, the goal is less to win a political argument against Republicans than to make sure the uninsured are at least willing to explore their options — and know where to go.
“The test of this is going to be is it working. And if it works, it will be pretty darn popular,” President Obama said in a July interview with The New York Times.
So far, the enrollment pitch is focused far more on health insurance than on the ObamaCare brand.
The states that are building their own insurance marketplaces haven’t emphasized in their own enrollment drives that the marketplaces are part of ObamaCare.
California launched its first television ads last week, adopting the same strongly local flavor as other states that are invested in the law’s success. Ads in California, Oregon, New York and elsewhere play to their states’ unique attributes and frame insurance as a basic safety net.
"Soon, Californians from Sacramento to Salinas to San Diego will have equal access to quality health insurance," one of California’s ads states. "Those who need financial assistance will get it. And nobody will be denied because of a pre-existing condition."
Many factors will determine whether the law ultimately works, and a fair assessment wouldn’t be possible on the day the exchanges open, but some of the key tests will nevertheless come into focus on Oct. 1.
The big practical question will be whether the exchanges work.
Some states are already treating Oct. 1 as a soft opening. Oregon won’t immediately open its marketplace to the public; consumers will need a licensed broker or “navigator” if they want to enroll in a policy through state’s exchange right away.
California officials are also preparing contingency plans in case their marketplace’s website experiences problems.
Obama has repeatedly acknowledged that “glitches” are inevitable as the new marketplaces come online.
Still, his critics are sure to highlight any snags as evidence of an implementation “train wreck,” and severe problems could pose real challenges to the overall enrollment effort.
The administration has had to test the “data hub” behind the new marketplaces at the same time it’s building the complicated new system. A final security certification for the data hub isn’t expected until Sept. 30.
The data hub must be able to interact with several federal agencies as well as the exchanges in all 50 states.
On top of maintaining that network, the federal government is building and operating all or part of the exchanges in 36 states.
“The job is made doubly difficult,” by states refusing to help implement the law, Health and Human Services Secretary Kathleen Sebelius said in a recent interview with Bloomberg.
The resistance from conservative states has strained federal resources, and some pieces of the law have been delayed so that officials can focus on getting the exchanges ready and encouraging people to sign up.
The White House and its allies know where to find the young, healthy uninsured people who are critical to the law’s success. They have targeted their audience down to the county level.
And they insist they’ll be ready on time.
“Here is what will build support, given that we’ve been outspent four to one from the other side with all kinds of distortions about healthcare. Here is what we’re going to do to beat back that misinformation. On Oct. 1, people are going to be able to start signing up,” Obama told the Times.