By Sharon Begley
NEW YORK, June 21 Call them Obamacare's army.
From the chief actuary at the California health insurance
exchange that President Barack Obama's healthcare reform law
established to the legions of call center staffers who will help
people trying to buy insurance through such state exchanges, the
number of people working to implement "Obamacare" has reached
the tens of thousands, a Reuters analysis has found.
No one said that overhauling healthcare, which accounts for
17 percent of all national spending, was going to happen with a
State offices that will run insurance exchanges are hiring
tens of thousands, either on staff or through outsourcing firms.
Federal agencies that are key to implementing the law, such as
the Internal Revenue Service, plan to hire thousands more, and
private non-profit groups backed by the White House are
dispatching thousands of newly hired staffers and volunteers
into the field.
The number of such workers, obtained through documents and
interviews with officials, consultants and contractors, could be
significant enough to produce a modest, if temporary, boost to
employment across several industries.
But the precise size of this workforce is shrouded in
secrecy. The Department of Health and Human Services (HHS) did
not reply to a question asking how many people it has hired or
assigned to implement healthcare reform, and companies with
government contracts worth tens of millions of dollars are
HHS spent $394 million through last March on contracts to
set up state insurance exchanges it will run, according to a
report this week by the Government Accountability office, the
investigative arm of Congress. Among them: an $88 million
contract with CGI Federal Inc. for information technology work
and a $55 million contract with Quality Software Services Inc.
(QSSI) to build a "data hub" that will allow people to buy
insurance on the state exchanges that are the heart of
But "we do not have information on the number of people
involved to implement it," said John Dicken, GAO's director of
Asked how many people its grant supported, QSSI
Vice-President Mark Labus said, "That's not information I'm
authorized to release."
What is clear is that relatively few of the
Obamacare-related jobs are in healthcare, at least so far. The
sector added an average of 24,000 jobs per month over the last
year, the Bureau of Labor Statistics reported this month.
Helping the uninsured buy coverage is expected to bring millions
more paying patients to doctors, clinics and hospitals starting
in 2014, but most providers have adopted a wait-and-see attitude
Advertising and marketing teams, however, have been working
for years. Porter Novelli, a public-relations giant, received
nearly $10 million from HHS to help implement Obamacare,
government records show - though it declined to reveal the
number of workers on the project. "We do not disclose head
counts of any sort," said Catherine Sullivan, director of
Another reason for the uncertainty about head counts is that
states are only now figuring out what kind of staffers they'll
need - like the marketing director California is trying to hire
or the executive who will "ensure cross team alignment and work
efficiency" that Oregon wants.
STATE BY STATE
To succeed, Obamacare must reduce the number of uninsured
Americans and make affordable policies available to them,
neither of which will happen unless millions of people buy
coverage on the exchanges. Experts say at least 2.7 million
younger, healthier people need to sign up to make the exchanges
work financially. The trick is reaching and persuading them.
One group that hopes to do so is Enroll America, a
non-profit with close ties to the White House. It had eight
staffers last year, 50 now, and is aiming for 200 this summer.
It will deploy thousands of volunteers to states such as Ohio,
Florida and New Jersey, where Republican leaders rejected
For states running their own exchanges, the numbers vary
Rhode Island has nine staffers, Nevada will have 12 next
month, Hawaii has 43 and Oregon has 141. But Covered California,
that state's new insurance marketplace, expects to have 398,
from Executive Director Peter Lee to a chief actuary and
director of marketing.
The big numbers are not in the central office, however, but
in the field.
Covered California will have 20,000 people helping the
nearly 10 million uninsured sign up for coverage, said
spokeswoman Anne Gonzales. It also expects to hire 500 agents
for a call center in Rancho Cordova, several hundred in Fresno
and up to 200 in Contra Costa, people from many walks of life,
including some who have been jobless for months and who will
receive intense training.
Figuring out how many people are needed to enroll, say,
1,000 of the uninsured and field calls from those who are
flummoxed by the online marketplaces is as much art as science,
said Bruce Caswell, president of Maximus Health Services, a
government contractor that handles Medicaid enrollment in 18
states and will run Obamacare call centers for Vermont, Hawaii
Maximus starts with estimates of the percentage of a state's
uninsured who are expected to buy coverage through its exchange.
It then estimates how many will call for enrollment help and
calculates the percentage likely to be "deflected" with a
robo-answering program ("press 3 if your address has changed"),
which is often about 20 percent, said Caswell. It then plugs in
the expected length of a call (four and a half minutes for
Medicaid enrollees) and out comes an answer: Maximus will need
25 staffers for Hawaii, where about 153,000 adults are
'WE'LL LOOK UNDER ROCKS'
Many of the groups sending forces into the Obamacare fray
are community-based healthcare organizations. Earlier this
month, Washington's Healthplanfinder announced grants of $6
million to groups to help people enroll for coverage, including
the Whatcom Alliance for Health Advancement.
The group will use its grant "to look under rocks if we have
to" and find Washingtonians eligible to buy insurance through
the exchange, said Deputy Director Elya Moore. "We'll go to
community events, health fairs and even the 93-mile 'Ski to Sea'
race" from Mount Baker to the coast, Moore said. They don't
envision hiring more members of their "access team," who help
people enroll in Medicaid and children's health insurance
Earlier this month, Colorado named 55 organizations, from
community groups like Hilltop Community Resources to Centura,
the state's largest hospital system, to help residents sign up
for insurance on its exchange. Among them: the Colorado Motor
Carriers Association, "the voice of trucking in Colorado."
At the federal level, Obama's proposed budget for the IRS
next year would allow the agency to hire nearly 2,000 employees,
according to a GAO analysis. The IRS will administer subsidies
(in the form of tax credits) to help people buy insurance
through the state-based exchanges ad level penalties on
uninsured adults who don't.
Obamacare imposes tricky mandates on employers, such as
requiring those with 50 or more full-time workers to offer
insurance coverage or pay fines, leading to warnings that
companies will have to hire many more employees to help them
comply with the law.
Most employers, however, are not staffing up.
A survey by the Society for Human Resources Management
released in June shows 74 percent of employers are sending
existing HR staff to training on the healthcare law, and 73
percent are working with their legal staff or outside
consultants to understand their options.
"Most of our clients are dealing with the requirements of
the law with their existing staff," said Randall Abbott, a
senior executive in the healthcare reform division at Towers
Watson, the consulting firm whose clients are large
employers. "They may be adding some support staff ... but our
experience has been that it's negligible."