The Obamacare Enrollment Deadline Is a Week Away, but There’s Little Mention of the Mandate

by Jonathan Cohn | March 24, 2014

The individual mandate has been Obamacare’s most controversial feature. And thanks to constitutional questions, it was nearly the instrument of the whole program’s demise. But it has gotten relatively little attention in the last few months, which is surprising and a little unsettling.

The mandate serves a very important purpose, after all: providing financial incentive for people to buy insurance before they get sick. But the threat only works if people know about it. In Massachusetts, which implemented a similar scheme in 2006, some (though not all) of the advertisements promoting enrollment stressed that carrying insurance had become “a requirement” and that people who failed to get coverage faced a financial penalty.

By the looks of things, official outreach efforts for the Affordable Care Act haven't given the penalty the same amount of attention. Instead, the primary, overwhelming focus has been on the security that insurance brings and the affordability of available plans. This emphasis may reflect marketing research. At the end of the day, those positive messages may resonate most with potential consumers. Or it could reflect political concerns. The mandate is among the law’s least popular features, according to the polls, and promoters might want nothing to do with a message that might further alienate an already ambivalent public. Or, you know, it could reflect both factors.

And yet...if a story by Louise Radnofsky in the Wall Street Journal is indicative, mandate messaging may be less important than it seems. Radnofsky spent some time in Kansas City, getting an up-close look at recruitment and enrollment efforts. And she found plenty of evidence that people don't need the government to tell them about the penalty:

On a recent weekend in Wyandotte County, which is one of the poorest parts of Kansas and is home to 36,000 uninsured people, the penalty loomed large in conversations about the law.

"I'd heard it's mandatory, that if you don't have it, you're fined," said Teresa Tovar, 36 years old, a stay-at-home mother of five. The family has a household income of $35,000 from her husband's job with a small sprinkler-systems company. She had been browsing plans online but hadn't committed to buying one when canvassers came to her door one Saturday reminding her of the March 31 deadline. …

[Mike Perry, whose polling firm PerryUndem researches consumer motivations for enrolling in coverage] said it's clear in his focus groups that people know about the penalty and cite it as a factor in looking at getting coverage, especially younger people and Latinos.

Most of the nonprofit groups around Kansas City are reluctant to shift their upbeat campaign about the opportunities offered by the law. "We don't do scare tactics," said Karimah Baptiste, outreach and enrollment coordinator for Swope Health Services.

But Lucia Jones —a former emergency-room nurse hired to coordinate an enrollment campaign for Wyandotte County by a health-provider coalition and the public health department—said she has been talking about the penalty in radio and in-person pitches about the law.

Maybe this shouldn’t be surprising. As Radnofsky notes, polls show that people know about the mandate. And because it’s nearly tax time, plenty of Americans are hearing about the penalty from tax counselors like H&R Block. That's one reason I've thought the administration might extend the deadline for open enrollment until April 15.

That seems unlikely now. And one reason is that the pace of enrollment is picking up. People following the trend most closely, like Charles Gaba of ACASignups.net, now predict the number of people selecting new private insurance plans through the new Obamacare marketplaces will exceed 6 million. That would be a little less than the 7 million most experts originally forecasted, but a little more than the 6 million figure that the Congressional Budget Office recently predicted after accounting for the early technical problems with healthcare.gov

Of course, that doesn’t account for the proportion of people who haven’t paid premiums or the fact that enrollment patterns will vary from state to state, with potentially low enrollment in a few causing the kind of actuarial problems that would lead to higher-than-expected premiums next year. On an individual level, those people who don’t know about the mandate might be unpleasantly surprised when, upon filing their taxes in 2015, they discover they owe the federal government extra money.

But if the polls and Radnofsky’s account are correct, most people don't need education about the mandate. Now if only they could become so informed about the rest of the law.

Source URL: http://www.newrepublic.com//article/117129/obamacare-individual-mandate-will-it-affect-enrollment