Amid relative silence from Trump, Obama comes out to bolster the ACA—and he's not alone

The Affordable Care Act's (ACA) fifth open enrollment period launched Wednesday with little fanfare from President Trump or his administration—but Obamacare's biggest advocate isn't sitting on the sidelines.

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After months of relative silence, former President Barack Obama splashed back into the health care scene with a video encouraging U.S. residents to enroll in coverage. He isn't alone: Advocacy groups and former Obama administration officials have spent the last few weeks ramping up outreach efforts in the face of growing confusion about the ACA and cut-backs to federal outreach resources.

A minimalist approach

Compared with Obama's administration, the Trump administration has taken a more minimalist approach to promoting exchange enrollment.

While the Obama administration celebrated the launch of each open enrollment period, Louis Gomez in a San Diego Union-Tribune opinion piece notes that neither the White House nor the HHS websites mentioned on Wednesday that the open enrollment period had just launched, and Trump as of Wednesday afternoon had said nothing about enrollment's opening day.

For many observers, the silence is concerning because polling shows that some U.S. residents could be unaware open enrollment is happening at all—and in fact, many wrongly believe the ACA has been repealed. A Morning Consult/Politico poll released last week found that 24% of respondents mistakenly believed the ACA had been partially repealed, while another 14% incorrectly thought the ACA either had been completely repealed or had been repealed and replaced with a new law.

Another area of consumer confusion, according the New York Times' Abby Goodnough and Robert Pear, are federal subsidies. Goodnough and Pear write that some consumers mistakenly believe federal subsidies available under the law to help offset their exchange plans' costs are no longer available, perhaps due to a misunderstanding of Trump's decision to end the ACA's cost-sharing reduction (CSR) payments to insurers. In reality, cutting off the CSR payments means some enrollees will receive higher subsidies, making exchange coverage more affordable.

Kelly Turek, a policy analysis at America's Health Insurance Plans, told Goodnough and Pear, "Consumers are unclear whether the [exchanges] still exist, whether they still have an obligation to get coverage," and "whether they can get financial assistance."

ACA supporters seek to promote enrollment, combat confusion

In light of the Trump administration's scaled-back approach, several advocacy groups, former policymakers, and ACA supporters have launched efforts to promote the current open enrollment period and to dispel misconceptions.

Obama appeared in a video on Wednesday encouraging U.S. residents to shop and sign up for plans on HealthCare.gov. The video was part of the Get America Covered campaign—which former CMS officials launched last month—that features celebrities, health policy experts, and political figures plugging the open enrollment period.

Meanwhile, Natalie Gagliordi writes for ZDNet's "Small Business Matters" that several online companies, including Etsy and Care.com, have launched an effort called "Tech United for Independent Access to Healthcare," under which the companies will provide freelancers and others with up-to-date information on the open enrollment period.

At the state level, a coalition of nonprofits in Kansas spent $66,000 on a television commercial promoting enrollment, developed fliers to counter misinformation about the ACA, and hired more enrollment assisters. The Epilepsy Foundation of Florida is hosting house parties during which navigators will help people sign up for coverage. Arizonans United for Health Care is working with other nonprofits and local activists to promote the open enrollment period. And in Pennsylvania, the state's insurance department dedicated $100,000 of its budget to an educational campaign to promote open enrollment.

States that run their own exchanges also have looked to bolster enrollment by investing in advertising and extending their open enrollment periods beyond the federal exchange's Dec. 15 end date. California's exchange is spending $111 million on open enrollment advertisements, while New York's exchange is spending $15 million. In comparison the Trump administration allotted only $10 million for open enrollment efforts in the 39 states that use the federal exchange.

Will the efforts pay off?

Despite state and private industry efforts to promote the open enrollment, several analysts project the Trump administration's scaled back outreach efforts will mean the exchanges will have fewer enrollees in 2018 than they did this year. But it might be a while until the enrollment picture becomes clear: While the Obama administration used to release weekly enrollment updates, it's not yet clear when the Trump administration will make such data available.

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