To get the young people whom the system needs to succeed into the exchanges will require more than just "navigators" and microtargeting key populations. Fortunately, if the Obama campaigns in 2008 and 2012 were good at anything, it was turning out and engaging young people, and that knowledge ought to be deployed in the campaign to sign people up for insurance, too. The campaigns made electing Obama a community project and a community conversation that involved meeting people where they were to talk about politics and voting. It involved barbershops and hair salons, coffee shops, laundromats, community organizations. Getting the insurance equivalent of low-information, unlikely-turnout voters to sign up for insurance—something much more complicated than going to the polls—will require tremendous work.

Just as Obama for America led the charge in 2008 and 2012, someone has to lead the charge to turn the conversation about getting insurance into something as engaging as the one about electing the president. OFA's "Healthcare for the Holidays" campaign to talk about insurance with your family at Thanksgiving is a good start. But OFA today is tiny compared to its size during the campaign cycles; for a campaign to work it will have to be enormous. And it will have to be strategic. Where are the office hours with navigators in high-profile communities of trendy young people? The Twitter Q & A sessions? The Reddit AMAs? The uninsured and the influential young aren't always the same people, but you're more likely to get the first if you've also got the second on board.

3. Make the Most of Medicaid Expansion: The expansion of Medicaid is both one of the greatest struggles and one of the high points of the system so far. The administration has actively pushed red-state governors to approve Medicaid expansions—the one area where there seems to be a concerted effort that's working. Working with every state that has agreed to a Medicaid expansion to create an Oregon-like opt-in system seems like the best way to go. If half of the uninsurance problem is going to be solved by expanding Medicaid anyway, and patients can be easily identified and enrolled without ever touching Healthcare.gov, they should be. This would help millions of people and be a surefire way to make Obamacare about more than a website.

4. Learn From the Best State Exchanges: While trying to fix Healthcare.gov, the administration should undertake a separate effort to see if it can reproduce the most successful state sites, so that as many states as possible can move out of the federal system before the next open enrollment period begins in October 2014. Some of the state-level exchanges have better tech than others—which is what you'd expect in the laboratories of democracy.

5. Get the Word Out: There needs to be a communications SWAT team to help make the ACA sites and information as easy to understand and accurate as can be. This can't be a traditional communications project geared toward managing the media—between the White House and HHS, there are enough people doing that—but rather a consumer-experience-oriented one focused on managing the forms, instructions, and private-sector efforts designed to help people understand how to get insurance through ACA and how to fill out the forms. If there are private-sector sites giving out incorrect information, someone should respond to them. If the online forms in a given state are hard to understand, someone should make sure they get corrected. If there need to be instruction manuals for how to apply—not just FAQs, but paper-and-ink ones people can underline and highlight and dog-ear—someone should publish them.

Nothing will ever take away the anxiety and passion people feel when it comes to dealing with their health insurance, because of what the product itself is designed to do. But a program of greater communication and more handholding all around might help reduce the drama, while helping the ACA fulfill its mission of expanding insurance coverage across America.

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