The targeting is the first piece of the puzzle. The information is not presented in a particularly user-friendly way, but the Census Bureau actually has fairly detailed information about the insurance status of the American people. Administration officials have a slideshow depicting their ability to draw detailed neighborhood-level maps that pinpoint which parts of Los Angeles or Dallas contain large pockets of uninsured young people. Since initially they need to reach only a minority of uninsured youth, the most cost-effective approach is to target these dense clusters.
Conveniently, these are also the places where the administration is most likely to find partners. Even in non-cooperating states, you have Democratic mayors, county commissioners, and state legislators in the major urban centers. Administration officials are counting on those local politicos to join with community health organizations and get the job done.
But the biggest piece of the puzzle will likely be money. Neither Democrats nor Republicans liked to emphasize how much the Affordable Care Act debate was about redistribution rather than health care as such, but there’s a lot of money here. People earning less than 400 percent of the federal poverty level (that’s $45,960 for a single person) are going to get tax credits to defray the cost of premiums. These subsidies greatly increase the number of relatively healthy people for whom Obamacare plans will be a good deal. About half the target population of uninsured young people — far more than the administration needs to sign up during the initial period — will be eligible for subsidies, meaning in principle they can get everyone they need just out of the subsidized group. Advocates can make the case to young people that they’ll be leaving money on the table by not signing up. Meanwhile, the very same people the administration needs to sign up are the ones who’ll be the most profitable clients for private insurers – so you can expect them to market aggressively as well. Already Walgreens and Blue Cross Blue Shield have announced plans for joint marketing of ACA plans, and other industry players will surely follow suit.
None of this proves the law was a good idea. It’s possible that Republicans are right and the taxes that pay for these subsidies — primarily a hike in the tax rate that high-income people will pay on investment income — will crush the American economy in the long term. But conservatives are certainly fooling themselves if they’re expecting a backlash driven by problems around implementation. The law is structured to be financially beneficial to a large majority of people, and the infrastructure is in place to make that clear to a critical mass of them. Snafus will be real enough, but broadly speaking, the rollout is going to be a huge success.
Matthew Yglesias, author of “The Rent Is Too Damn High,” is Slate’s business and economics correspondent.