First, that a whopping 78 percent of the people they're intended to help — the uninsured — have no idea the exchanges are coming.
Second, that getting people to enroll in even well-known programs historically has been difficult.
"One of the things that we know makes a difference is outreach," said Klein, executive director of Enroll America.
Last week, the Washington D.C.-based nonprofit announced a nationwide campaign focused on getting the uninsured to use the exchanges, both by increasing awareness and by assisting developers in creating user-friendly processes for the exchanges.
States that create their own exchanges or enter a partnership aren't likely to need a lot of help with marketing, Klein said, because of the federal grants they're receiving. California, for example, has been awarded $674 million and plans to use $250 million of that for a two-year marketing campaign.
By contrast, the public relations contract that Weber Shandwick has to publicize the exchanges in states that chose or defaulted to the federal option — 26 at last count, including Pennsylvania — is for $3.1 million.
Melissa Fox, Pennsylvania Insurance Department spokeswoman, said the exchange grants Pennsylvania was awarded prior to its decision to go with a federally facilitated exchange included funds for consumer marketing outreach and education, but the department has not used any of the money associated with those tasks.
"While we may not be undertaking the operation of a state exchange, Pennsylvania will not be abandoning its responsibility to regulate the insurance market, including its role in assisting and educating Pennsylvanians on how to best meet their health insurance needs," PID commissioner Michael Consedine wrote in a Jan. 10 letter to Health and Human Services Regional Director Joanne Grossi.
Noting that the changes slated for 2014 "may easily lead to consumer confusion and severe market disruptions, particularly if regulators, insurers and consumers are not adequately prepared," Consedine asked for dialogue with HHS on specifics of the exchange.
"We will continue to do our best to prepare and educate our consumers with the limited information we have," he wrote.
Enroll America, which already has a sizable list of organizations and businesses that have agreed to join its efforts, is seeking to raise $50 million to $100 million and hopes for contributions from corporations that will benefit from the expansion of the insured population, Klein said.
The exchanges are scheduled to open Oct. 1, with coverage beginning Jan. 1, 2014. PPACA requires the exchanges be designed with a single application that works for both Medicaid and private insurance, with applicants routed to the correct program based on their answers. The initial open-enrollment period will last six months, through March 31, 2014, but subsequent ones will be just seven weeks.
About 49 million nonelderly Americans are uninsured, according to Enroll America. Two-thirds of them are in 12 states, of which Pennsylvania is the ninth, and 32 percent of them are Hispanic.
If all states opt for the full Medicaid expansion, 41 percent of those 49 million people will be eligible for Medicaid, Klein said. Another 37 percent will be eligible to receive a subsidy when purchasing insurance on an exchange, and 9 percent will be eligible to use an exchange but not to receive a subsidy. The remaining 13 percent will be ineligible due to immigration status.
The health insurance exchanges, which federal officials have recently begun calling marketplaces, will be open to individuals and small businesses.
Depending on their financial situation, uninsured individuals may qualify for Medicaid through the marketplace or receive a subsidy to purchase private insurance offered on the marketplace. Individuals whose employers offer insurance but require premium cost-sharing that equals more than 9.5 percent of their income may also qualify for subsidies to purchase insurance on the marketplace.
Those whose income is 400 percent or more of the federal poverty level will not receive subsidies but can still purchase insurance through the marketplace.