The hard sell

Nearly a decade ago, the first-year growing pains of the Medicare drug benefit drew a heated yet largely supportive political response. Politicians railed against government incompetence as nightly news reports featured dazed seniors sifting through the multiple plan choices offered on a government website. Newspapers editorialized about missteps in the program.

Yet within a few years, virtually all of those transient reactions turned into solid support for the program. Tens of millions of seniors figured out how to take advantage of the new benefit. They richly rewarded the private-sector firms that bet on its success. The insurance companies who sold the private policies had a wedge for selling their Medicare Advantage plans, and the drug companies profited greatly from the expanded market.

In fact, the program was so successful that Democratic leaders quickly turned to how to plug gaps in the coverage, the so-called doughnut hole. It was largely eliminated by the Patient Protection and Affordable Care Act.

What a difference between that experience and the rollout of the ACA, now just a few months away.

In 2004, the only real opponents of the expanded drug benefit were the fiscal hawks who complained bitterly about adding a new unfunded mandate to Medicare. The political operatives in the White House—then in the middle of a re-election campaign for President George W. Bush—knew precisely what they were doing when they co-opted one of the few domestic policy issues where the incumbent was vulnerable. There was no political upside to the Democratic challenger opposing a Republican-backed Medicare drug benefit.

Contrast that with the Republican response to the law they disdainfully call Obamacare. The attitude behind the dozens of House votes symbolically repealing the law was summed up in an attack ad unveiled last week by Crossroads GPS, the brainchild of Republican kingmaker Karl Rove. Entitled “ObamaCareNado,” the faux horror movie trailer compares insurance expansion to a tornado ravaging the countryside. “The perfect storm—it's coming. Are you ready?” the deep-voiced narrator intoned. For Republicans, the existence of the uninsured simply isn't a problem that needs addressing.

That hasn't been lost on the White House, which now sees the Obamacare rollout as its latest political battle. According to recent news reports, former Obama campaign operatives are holed up in the West Wing devising tactics that mimic their two successful runs for the White House. They're identifying key precincts—but this time they are focusing on the ones with high numbers of invincible youths and poor, working-class families, the two groups that make up the bulk of the people with jobs that don't provide health coverage.

They are setting up call centers to reach them. They are planning targeted media campaigns in the Hispanic community. They've enlisted Hollywood stars and sports heroes. They will even show up at bourbon festivals in Kentucky, according to one story.

A month ago, Modern Healthcare reporters Rachel Landen and Ashok Selvam reported that insurers and providers are also laying plans to help sign up the uninsured. To be frank, those efforts seemed rather sparse and low key—hardly worthy of the political battle that lies ahead.

It was always going to be a difficult task convincing the uninsured to buy a product that most have no experience using and aren't convinced they need—even with subsidies. Imagine how hard it's going to be when opposition ads are running in every media market that liken health insurance to a tornado that destroys jobs and will undermine existing coverage.

No one knows the uninsured better than the providers who service their healthcare needs—often in their emergency room without reimbursement, where the costs get spread to every other insured patient. The public will know those providers have joined the campaign to sign up the uninsured when some of those stories start popping up in local media outlets to counter the effects of a Category 5 ObamaCareNado.

Follow Merrill Goozner on Twitter: @MHgoozner