Legacy on Line in Fierce Drive on Health Law

Royal blue and emblazoned with the White House seal, the “Official Affordable Care Act Enrollment Countdown” is a paper calendar that keeps track of the time before uninsured Americans can begin signing up for coverage under the president’s signature health care law.

On Tuesday, the top page said simply: “70 Days Left.”

The message is clear. Few things are more important to the White House this year than a successful health care rollout on Oct. 1, when millions of uninsured Americans will be required to obtain private health coverage in government-run marketplaces. Getting it right — or wrong — will help determine Mr. Obama’s place in history.

Enter the Obamacare Team, some two dozen political operators and data-crunching technocrats charged with carrying out the biggest health care overhaul since Medicare in the 1960s — but with more pitfalls. Their job is to sell the law to large numbers of Americans who remain divided about its value and wary of its impact. Republicans have seized on one Democratic description of the health care law as a “train wreck,” particularly after the administration announced a politically damaging one-year delay in a key provision of the law.

Working out of war rooms in the West Wing basement, the Eisenhower Executive Office Building and the Department of Health and Human Services, the team is first trying to find in the next year 2.7 million uninsured people between 18 and 35, most of whom are healthy. Just as Mr. Obama’s electoral success hinged on the turnout machine he created in Chicago, the fate of the health care law rests on whether his administration can turn out and enroll the uninsured.

“The key for us is to take this out of the abstract and make it very, very, very real,” one of the leaders of the effort, David Simas, told a dozen White House aides during a strategy session in the West Wing last week.

Mr. Simas, a top strategic adviser to the president, was in charge of the 2012 Obama campaign’s effort to understand voter sentiment and opinions. His challenge now is to apply the same techniques of microtargeting to the health care law.

In spreadsheets and PowerPoint presentations, Mr. Simas rattles off statistics from individual census tracts, like one in Texas that has 6,737 uninsured African-Americans 18 to 35 — exactly the kind of people he needs to find. “It’s all about designing outreach,” Mr. Simas said, with maps of Dallas on his two computer screens. “It’s getting people to the front door.”

The team is also turning to Hollywood. Jennifer Hudson, Amy Poehler, Aisha Tyler and representatives for Oprah Winfrey, Jon Bon Jovi and others were at the White House on Monday for a meeting with Valerie Jarrett, Mr. Obama’s senior adviser, on plans for them to promote the health care law through social media, public service announcements and television appearances. Mr. Obama briefly stopped by, saying they needed to urge young people to sign up.

Hours later, Ms. Tyler told David Letterman on his show that the president was “trying to enlist people to help people understand the Affordable Care Act and know that young people can get insurance where they couldn’t afford it before.”

The main portal is healthcare
.gov, where the uninsured can sign up for health plans starting on Oct. 1. For now, the Web site is full of what the White House hopes is nonthreatening, user-friendly information, with a goal of making shopping for health care like buying a book on Amazon. On a whiteboard in his West Wing basement office, Mr. Simas sketched out the simple Web site screens for buying insurance that visitors should see in October.

The team has spent months coordinating with insurance companies, state officials, pharmacies, health centers, hospitals, mayors and sports teams. Tara McGuinness, the chief communications adviser for the effort, has a spreadsheet showing some of the thousands of Walgreens pharmacies that are to help spread the word. In Kentucky, organizers are planning to pass out information at the state’s popular bourbon festivals.

The federal government has already set up call centers to field questions, allocated $150 million for workers at community health centers to help administer the rollout, and created “red teams” of computer specialists operating out of a building in Columbia, Md., as a strike force to confront technical problems.

Overseeing the entire effort is Mr. McDonough, a former deputy national security adviser, who talks about “real-time feedback” and vows to “recalibrate our coordinates” when Republicans criticize the health care law. “The way I am attacking this is the way I attacked a lot of problems at the national security staff,” he said in an interview. “We have a strategy. We have a target. It’s my job to make sure that everyone is keeping focused on the target.”
But much remains out of their hands. The federal government has full control over the insurance marketplaces in only 19 states. An additional 17 are being managed completely by the states and the District of Columbia, and 15 are joint ventures. Getting the computer systems to talk to one another is a challenge, much as it was in 2006, when more than 22 million people enrolled in a new Medicare drug benefit.

Even though the beneficiaries were already on the Medicare books — the Bush administration did not have to search for them — the first months of the sign-up were chaotic.

“The data definitely did not flow smoothly,” said Mark B. McClellan, who was in charge of carrying out the Medicare change for President George W. Bush and has talked with Mr. Obama’s team this year. “All it takes is 1 percent of things not working smoothly to have tens or hundreds of thousands or even millions of people with problems.”

Many of Mr. Obama’s allies across the country remain concerned about computer glitches, confusion at hospitals, a blasé attitude among uninsured Americans and the possibility that people will be victimized by insurance fraud as they try to buy coverage for the first time.

“We have a couple million people coming in, and so much money involved,” said Dave Jones, the insurance commissioner in California and a supporter of the health care law. “I want to make sure those consumers are not taken advantage of.”

In Virginia, state officials working with the federal government to create a health insurance marketplace say they fear computer problems and misunderstandings among buyers. “What keeps me up at night is once the national messages start going out, people in my state are going to be confused,” said Cindi B. Jones, the director of the Virginia Health Reform Initiative. “When there’s confusion, who are they going to blame? The state? The feds? It’s just the circumstances of too much to implement too soon.”

Republican critics, meanwhile, are gearing up. On the same day last week that Mr. McDonough handed out the countdown calendars to his staff, House Republicans voted again to repeal the heart of the health care law, the requirement that all individuals obtain health insurance or face a fine. Arguing for repeal, Speaker John A. Boehner mocked the law. “Not ‘fabulous’ or ‘wonderful,’ ” he said. “A train wreck.”

The next day, the conservative group Crossroads GPS, co-founded by Karl Rove, the Republican strategist, began running a video called “ObamaCareNado” comparing the law to a tornado ripping through a terrified community. “A rising tide of health care costs,” a narrator intones. “Nobody safe from its wrath!”

Mr. McDonough vowed that the Obamacare team would fight back. “What they won’t do is stop us,” he said.