Health and Science

Obamacare outreach: Lots more snail mail, Instagram videos pushing you to sign up

A person holds a sign directing people to an insurance company where they can sign up for the Affordable Care Act, also known as Obamacare.
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These guys really, really, really want you to sign up for Obamacare — and they're not going to let you forget it.

Federal health officials Thursday revealed new details of an upcoming outreach effort to get people to enroll in Obamacare plans for 2017. That will include significantly boosting the amount of traditional mail and social media channels they use, as well as increasing the number of TV ads around a key sign-up deadline.

"For every dollar spent, we're going to be smarter, and more targeted, and more effective," said Dr. Mandy Cohen, chief operating officer and chief of staff of the federal Centers for Medicare and Medicaid Services.

Details of the efforts come less than three weeks before the Nov. 1 start of open enrollment in individual health insurance plans, the kind of coverage that is sold on government-run Obamacare exchanges as well as outside of those marketplaces.

They also come in the face of a wave of news about price increases, often very high ones, facing customers whose health plans are not subsidized — and as advocates try to get more younger, healthier people enrolled in Obamacare plans to financially stabilize the market.

In a report issued Thursday, S&P Global Ratings said that "after two years of successive growth in [Obamacare] marketplace enrollees, 2017 will likely see a significant slowdown in this pace."

"We forecast 2017 [Afffordable Care Act] marketplace enrollment to range between 10.2 million and 11.6 million," which would represent at best 4 percent year-over-year growth, and at worst an 8 percent drop," S&P said.

The report noted that "increased outreach" to uninsured people will add to enrollment. But potential premium increases will lead to drops in the number of customers who don't receive financial aid, the report added.

Josh Peck, chief marketing officer of the federal Obamacare exchange, said the outreach that officials hope will boost enrollment would reinforce three messages: The "affordability" of Obamacare plans for many people who are eligible for financial assistance; the deadlines for enrollment; and "the penalties for not getting coverage."

Research from past outreach has shown those messages are the most effective drivers of getting people to sign up, Peck said.

Officials said they will be sending out 10 million pieces of mail targeted to uninsured people and people who have previously expressed interest in getting Obamacare or Medicaid. That's more than 10 times the 800,000 pieces of direct mail the administration sent out in enrollment outreach efforts last year.

For the first time, officials said, will be using the social photo-sharing site Instragram to run images and videos explaining how to sign up for health insurance, why people should be doing so and the financial aid that is available to many consumers.

They pointed out that Instagram's users include more than 48 million millennials, the cohort of young adults much desired by insurers for the premium dollars they pay and their relatively low use of health benefits.

The huge social media sites Facebook and YouTube also will be used to carry ads, officials said Thursday.

Officials previously revealed that their outreach effort for the first time will also include using the popular social video platform and gamer site Twitch.

"Americans deserve affordable coverage, and we are running a data-driven program to better connect eligible people with health insurance," said Kevin Counihan, CEO of, whose marketplace sells coverage in 38 states. The remaining states' residents can buy plans on exchanges run by their individual states.

Officials also said Thursday that they would be using "smarter TV advertising," doubling from the same time last year the amount of impressions a consumer sees on TV about enrollment in the week leading up to Dec. 15. That is the date by which a person must be enrolled in an Obamacare plan to have it effective as of Jan. 1.

Likewise, officials said they would be "smarter" about use of email to encourage sign-ups, noting that the email list of has grown by more than 30 percent, up to more than 20 million people, from the end of the summer.

"We'll be able to send email reminders in near-to-real time if they open an account, start an application, or select a plan," CMS said in a statement about the outreach.

When asked how many people officials expected or hoped would enroll after all of these efforts, Cohen, the chief of staff of CMS, said, "We're not talking about any projections," during a conference call Thursday with reporters.

"We did intend to have projections before open enrollment" begins, Cohen said.

Open enrollment runs through Jan. 31. People who don't sign up for health coverage of some sort, Obamacare or otherwise, by that deadline face a potential tax penalty of the higher of 2.5 percent of household income, or more than $695 per adult.

In addition to highlighting that data and that potential fine, Peck said, the outreach effort would be focusing consumers' attention on the affordability of Obamacare plans. About 85 percent of currently uninsured people who would be eligible for Obamacare plans also could qualify for some level of financial aid to lower the cost of their monthly premiums.

That aid is available to people with low and moderate household incomes, below about $100,000 for a family of four.

Peck noted that the aid largely insulates eligible consumers from even the double-digit percentage increases that some insurers are imposing on their premiums for next year.

He said even if plans increased their premium rates by 25 percent compared to last year, 73 percent of Obamacare customers could still find a plan that would cost them $75 or less after their financial aid is factored in.

"The headline rates do not reflect the rates that most people actually pay," Peck said.

However, people who make more than four times the federal poverty level, or $47,520 for a single person, are not eligible for Obamacare financial aid. Neither are people who buy individual health plans outside of the government-run marketplaces. Those people will feel the full effects of premium price increases.