(Bloomberg) — The questions kept coming up across Michigan as soon as the Supreme Court said it would take up a case that could reshape "Obamacare" by ending insurance subsidies in many states.
Dizzy Warren, director of Michigan's biggest Patient Protection and Affordable Care Act (PPACA) exchange program enrollment group, dealt with it in her presentation to health-care advocates last week in Detroit, then again on yesterday's conference call with 57 workers: What do we do now?
Her answer? "Keep calm and keep enrolling," she said.
Organizers are bracing for more skepticism and confusion as the second year of enrollment begins Saturday under PPACA, which has promised health insurance to tens of millions of Americans without it. In the past two weeks, Republicans won control of Congress and pledged to chip away at the law, the Supreme Court agreed to review the case that challenges who's eligible for insurance subsidies, and the Obama administration lowered the bar for its enrollment goals.
Now comes the toughest challenge: signing up uninsured Americans who are confused, clueless or downright hostile to the programs available for them.
"It seems like the program itself is trending in the wrong direction, not in the right direction," said Les Funtleyder, a health-care portfolio manager at ESquared Asset Management in New York. "Momentum seems to be going against them, not for them."
The administration said this week it expects coverage to expand to about 10 million at most — 2 million more than this year and 3 million fewer than congressional budget analysts had estimated.
Brief call
Open enrollment runs from Nov. 15 to Feb. 15, and until recently, the administration's allies said they hadn't heard much from the government about its plans for the year. That began to change with a brief conference call Nov. 7 with President Barack Obama and his secretary of Health and Human Services (HHS), Sylvia Mathews Burwell.
Burwell makes her first trips to promote the law outside Washington today, with stops in Cincinnati and Columbus, Ohio.
"We are confident that we are going to have a successful open enrollment," Burwell said this week at an event hosted by the Democratic-aligned Center for American Progress. Success, she said, means that PPACA continues to dent the "fundamental number," the U.S. uninsured rate, which is down about four percentage points this year to 13.4 percent, according to Gallup Inc.
Black eye
The collapse of the online federal enrollment system in October 2013 was a black eye for Obama, Democrats and their political supporters promoting the law.
This year, Obama installed new managers at the agencies that supervise enrollment, who in turn say they have subjected the system to far more extensive testing than a year ago.
"There is huge pressure on the administration to make this thing work and be pretty seamless," said Robert Blendon, a health policy professor at Harvard University. "It's going to be a bit tougher, because you're enrolling people who for whatever reason were not that excited to sign up last year."
Cost is one problem, Funtleyder said. In many parts of the country, insurance premiums are high for people whose incomes aren't low enough to qualify for financial assistance.
Brett Mills, the owner of a home health-care agency in Chugiak, Alaska, twice voted for Obama, optimistic that under the health law he and his wife might obtain health insurance for the first time since 2005. He's been disappointed.
Can't pay
Mills and his wife, Lorna, make about $120,000, he said, too much to qualify for tax credits to reduce their premiums. The cheapest plan available to them on HealthCare.gov would cost $1,382 a month and carry a $10,500 deductible.
