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Final Obamacare push will pitch to the low-income young

By David Morgan

WASHINGTON (Reuters) - In the final months leading up to the launch of the key piece of President Barack Obama's healthcare reforms, the administration is preparing a public-education campaign designed to connect directly with the audience most critical for the law's success.

The effort will focus on selling the merits of the Patient Protection and Affordable Care Act to 2.7 million Americans with little or no health coverage, who are 18-to-35 years old, mostly male, and largely nonwhite, including many who are black or Hispanic, officials involved in the planning told Reuters.

The idea is to get them enrolled in private health plans through online marketplaces that will offer coverage in all 50 states at prices defrayed by federal subsidies, which many should qualify for because of their lower incomes and lack of adequate insurance.

Participation of young consumers is central to the success of the new state healthcare exchanges, and Obama's reform law, because the young tend to have little need for medical services and are cheaper to insure. That will compensate for older, sicker people who are expected to sign up in droves because the law bans discriminatory pricing and treatment for those with preexisting conditions.

Some supporters of the 2010 law have worried in recent months that the administration was not doing enough to inform this group, and the public generally, about changes the reforms will bring. Of particular concern is the word on the healthcare exchanges, where individuals and families with low-to-moderate incomes will be able to purchase private health insurance at prices set according to income.

Current and former administration officials said the outreach will employ the same methods used in Obama's reelection campaign, which relied heavily on social media, grass-roots organizing and demographics to reach young people, minorities and women. Members of the young target audience tend to be concentrated in major metropolitan areas, and about a third are believed to live in just three states: California, Texas and Florida.

"Whatever happened in the past 3-1/2 years, this is the most important moment now because we're no longer dealing in abstraction. Millions of people are going to be able to touch and feel something," said David Simas, who oversaw opinion research for Obama's reelection. He became a deputy senior adviser to the president in February and is one of the leading advisers for the campaign.

Due to begin this month, the marketing push will cost hundreds of millions of dollars and will complement promotions by private groups including the nonprofit Enroll America, which is headed by a former Obama White House aide and supported by healthcare groups, private companies and consumer advocacy organizations.

Officials say the government outreach will be covered by about $1.25 billion the administration has scraped from funds within the Department of Health and Human Services (HHS) and the original congressional allocation for implementation.

Republicans in Congress have blocked new money for the effort so they can use its failure as a winning issue in the 2014 congressional midterm election campaign. House Republicans just voted to repeal the law in what was their 37th attempt to kill or defund some part of it.

Reuters spoke to several government officials, including Simas, about the implementation drive.

The objective is to "surround" low-income young adults with messaging about the healthcare benefits by tapping channels more apt to reach them: cable television, radio, churches, Facebook, Twitter, YouTube, online chat rooms and youth-oriented magazines. The White House and HHS are also in discussions with celebrities, sports leagues and franchises that may be willing to help promote coverage.

The Spanish-language cable networks Univision, Telemundo and impreMedia are already considering a nationwide expansion of their joint media program, which has been praised by Obama, to advocate for healthcare reform in California. The three news competitors have agreed with a private healthcare foundation, called the California Endowment, to encourage Latinos to enroll in the state's health insurance exchange by sponsoring print, television, radio and Web-based promotions.

One White House official said the youth-targeting strategy was so important to the success of enrollment that if it didn't work, none of the larger efforts would make a difference.

The Affordable Care Act (ACA) - widely referred to as Obamacare by many Americans - has already begun to bring fundamental changes to the $2.8 trillion healthcare system through a series of reforms aimed at lowering out-of-pocket costs, improving access to preventive care and encouraging new healthcare business models intended to restrain cost growth.

Beginning October 1, the law will also begin offering subsidized health coverage to millions of low-to-moderate income people through the online state-insurance marketplaces and an expansion of the Medicaid program for the poor in states that accept the provision. Coverage begins January 1, when the law takes full effect, and individuals who don't have it will face a penalty that begins at $95 in 2014, rising to 2.5 percent of annual income in 2016.

The government aspires to sign up 7 million uninsured and under-insured Americans in the first year of reform.

NO HARD SELL

Obama has avoided the bully pulpit since signing the healthcare legislation into law, according to former advisers who concluded that strong public opposition would not begin to change until after the reforms became tangible.

But the president has made two public appearances over the past month to explain the ACA benefits. During the October 1-to-March 31 enrollment period, he will do more, though sticking with the soft sell, said administration officials.

Critics complain the White House has adopted too low a profile on health reform so far, and fear the effort to explain to a skeptical and in many cases misinformed public is coming too late to persuade them that participation is a good thing.

One of the most prominent recent critics has had a change of heart. Democrat Max Baucus, chairman of the Senate Finance Committee, sounded the alarm in April about how few details were shared with Congress about outreach efforts. He warned of a coming "train wreck" if the administration were to fail to enroll enough Americans for coverage.

The comment, which was zealously seized upon by healthcare reform's Republican foes, clearly worried the White House. Since then, Chief of Staff Denis McDonough has taken on a more prominent behind-the-scenes role by holding meetings every two weeks with Baucus on healthcare. He chats as often by phone with HHS Secretary Kathleen Sebelius.

"I'm more confident about implementation today," Baucus said in a statement in response to a query from Reuters. "The administration has been much better about keeping me and my colleagues up-to-date on their efforts."

To prepare for the autumn enrollment, White House officials say Sebelius and her lieutenant, Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, will travel this summer to meet with local leaders and community organizers as part of a "soft-education campaign" about coming benefits.

By the time the marketing push gains momentum in September and October, government officials say an important messaging advantage will be working in its favor.

As many as two-thirds of the intended audience, they say, have had insurance coverage but lost it after being laid off or switching to an employer who doesn't offer it. That means the message can focus on the cost and relative value of the plans. Pricing information is still being worked out, but premiums will run more than the penalty. One fear is that the $95 disincentive is too low to prompt young people to pay more for insurance they may not believe they need.

The worry is unwarranted, said Simas. "When you ask a 26-year-old male or female why they don't have insurance, they say they can't afford it - 'The job doesn't offer it, I can't afford it.' Rarely will you hear that it's not important."

(Reporting by David Morgan; Editing by Michele Gershberg, Fred Barbash and Prudence Crowther)

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