The 18- to 34-year-olds who helped elect Barack Obama could consign his signature domestic policy achievement to failure.

That’s because not enough millennials have signed up for Obamacare to make it work well.


Despite repeated outreach — including entreaties from all manner of celebrities, including NBA stars and Obama himself — young people make up less than 30 percent of Obamacare customers. The White House had set a goal of 40 percent in that age bracket to sustain a healthy marketplace because millennials tend to be healthier and, therefore, balance the costs of sicker, older customers.

The president was expected to make a pitch directly to college students at the University of South Florida in Tampa Wednesday, touting the law as one of his signature accomplishments while also acknowledging that it needs fixes to survive. However, his speech was canceled because of preparations for Hurricane Matthew, the White House said Tuesday.

This sign-up season, the administration is trying out new tools and strategies: Young people who live by their smart phones will find it easier to enroll with a few swipes. They’ll see ads for Obamacare when they go to sites like Twitch, where millions of users watch others play video games.

Community colleges, meanwhile, have agreed to help publicize open enrollment beginning Nov. 1, and Lyft is offering discounts to people using the ride-hailing service to attend enrollment events which are being held at pizza places and breweries.

For the first time, too, the administration will target those that opted to pay Obamacare’s penalty instead of to purchase coverage in the past.

The success of the Obamacare markets overall may very well hinge on whether these new strategies overcome millennials’ concerns about affordability and the lingering toxicity of Obamacare politics in states with the highest uninsured rates.

A trio of high-profile national insurers have significantly scaled back their Obamacare markets for 2017 because of big losses, as have some regional health plans across the country. An August analysis by the Kaiser Family Foundation, a nonpartisan research organization, found that 1 in 5 Obamacare customers might have only one insurer selling plans in their area for 2017. Many are posting big premium increases.

Many regard young people as the antidote to the turbulence since they are generally healthier and lower-cost — but that's also why many millennials feel no urgency to sign up.

"They're young, they don't get sick very often, and they just think, that's just an added expense that [they] don't want to have right now,” said Sonia White, who oversees Obamacare enrollment efforts at the Community Council of Greater Dallas. "They've always been kind of a tough audience."

For the law’s first three open enrollment periods, young adults accounted for 28 percent of sign-ups nationwide, according to administration data.

“They're not enrolling in the numbers we'd like them to,” said Karen Basha Egozi of the Epilepsy Foundation of Florida, a nonprofit that received a $1.8 million federal grant this year to enroll people into Obamacare plans. "Affordability is an issue for all age groups, but particularly for the young people.”

This sign-up season, though, it may be harder to notch large gains because the pool of uninsured Americans has shrunk to historic lows since the markets launched in 2013.

In addition, many prospective customers still don’t realize they may qualify for generous federal subsidies that would shield them from large premiums. Most enrollees receive subsidies that, on average, cover about three-quarters of their monthly premiums. And even with premiums rising at higher rates for 2017 coverage, most enrollees will be able to find a plan for $75 per month or less after subsidies are factored in, administration officials say.

Local enrollment workers from organizations across the country say they’re emphasizing affordability and the benefits of being insured, as they have in the past. But this enrollment season, they’re going to new places where they can find uninsured millennials.

For the Community Council of Greater Dallas, that means airing Obamacare enrollment ads in movie theaters for the first time. In and around Charlotte, N.C., Legal Services of Southern Piedmont is partnering with breweries and pizza parlors to hold sign-up events. Although young adults live on their mobile devices, enrollment aides say they still value in-person help when it comes to buying health insurance.

“We know this is a big decision for people,” said Madison Hardee, whose Charlotte legal services organization is part of a broader North Carolina consortium working on enrollment.

As enrollment workers are chasing down new Obamacare customers, they’re also working hard to retain those who are already enrolled.

Elizabeth Colvin, director of Insure Central Texas, says the organization’s primary goal is reaching out to current enrollees to encourage them to shop around for the best plan. If returning customers don’t research their options, their coverage could be automatically renewed into a more expensive plan.

She also worries that the steady drumbeat of bad news about premium increases and insurer exits in recent months will curtail enrollments. That’s particularly a concern in a deep red state like Texas, where hostility toward Obamacare is deeply entrenched.

“You will still have choices,” Colvin said. “It’s just this perception that it’s not working. If people have that perception, they’re not even going to research it.”

Amelia Goldsmith, who has worked on Obamacare outreach in New York and Virginia, has seen how misinformation has hurt sign-up efforts. She recalled meeting with a Virginia woman in her thirties who didn’t want to enroll even though she qualified for highly subsidized insurance. The reason: She didn’t want a computer chip implanted in her head.

“I almost got her to sign up,” Goldsmith recalled. “The bitter politics, they’ve been a massive impediment.”

Hardee, of the Charlotte-based enrollment group, expressed optimism that more young adults will sign up this year. She pointed to the increased penalty for skipping coverage, which this year jumped to $695 or 2.5 percent of household income (whichever is greater). But insurers have also said the penalty isn’t strong enough to incentivize Obamacare holdouts to purchase coverage — especially if they’re worried about being able to afford the monthly premiums.

"We all have a responsibility to continue to outreach and educate the millennial population,” said Scott Streator, senior vice president of CareSource, an Ohio-based insurer that has about 100,000 exchange enrollees across four states and is set to raise rates on average between 13 percent and 40 percent.

Streator said the insurer did a focus group with insured millennial men last month. Every person said plans needed to be more affordable.

“They want to do the right thing,” he said.