* Democrats worry as fall enrollment period draws near

* Potential repercussions for Congress, Obama presidency

* Frustration over lack of details on public outreach

By David Morgan

WASHINGTON, May 5 (Reuters) - Healthcare reform should be the signature Democratic achievement of President Barack Obama's presidency.

But with "Obamacare" five months from show time, Democrats are worried about whether enough Americans will sign up to make the sweeping healthcare overhaul a success - and what failure might mean for Congress heading into the 2016 presidential race.

Some of the law's main advocates fear that not enough of America's 49 million uninsured will know about health coverage offered in their own states. Even if they do, new insurance plans may not be attractive to young, healthy consumers needed to offset an expected influx of older and sicker patients.

Only a handful of states are beginning campaigns to promote the online health insurance marketplaces created by the law. Known as exchanges, the markets will offer private coverage at federally subsidized rates to individuals and families with low-to-moderate incomes, with enrollment set to begin Oct. 1.

The federal government has kept quiet about its promotion plans, which are expected to begin in earnest over the summer.

While Obama and his administration say they are working nonstop on reform, analysts believe a poor performance could make the Patient Protection and Affordable Care Act a big enough campaign issue in 2014 to jeopardize Democratic control of the Senate - particularly if insurance costs rise sharply.

"There is reason to be very concerned about what's going to happen with young people. If their (insurance) premiums shoot up, I can tell you, that is going to wash into the United States Senate in a hurry," said Senator Ron Wyden, an Oregon Democrat.

Some Democrats are frustrated about the lack of details surrounding administration plans to promote the exchanges.

Senator Max Baucus, a chief architect of the reform law, said federal outreach efforts deserve a failing grade so far and could be heading for a "huge train wreck." He criticized Health and Human Services Secretary Kathleen Sebelius for the scant information her department has provided.


FUNDING EMBARGO

"Why in late April can't they show us any of what they've got planned? The rollout plan should already be in existence," an exasperated Democratic Senate aide said separately.

The law is expected to cover 15 million Americans next year through the exchanges and an expansion of Medicaid. The overall number is forecast to jump to 38 million by 2022.

Reform is facing challenges on several fronts. Big insurers appear wary of participating, raising questions about how competitive the exchanges will be. Businesses are mounting a new legal effort to stop the use of federal subsidies in exchanges run by Washington. And most states have balked at the exchanges and the Medicaid expansion.

Meanwhile, the enrollment effort is under threat from months of delay, a congressional Republican embargo on new funding and worries about how affordable the new plans will be, according to analysts, lawmakers, congressional aides and former officials.

"I don't see how what they're planning to do is going to be adequate. The resources are too limited, the (law's) penalties are too weak and elite opposition in much of the country will undermine" enrollment, said Paul Starr, a Princeton professor and former health adviser to President Bill Clinton.

Add to that the challenge of reaching a public that is highly skeptical and often misinformed about the most complex social legislation since Medicare and Medicaid in the mid-1960s.

A Kaiser Family Foundation poll found that 77 percent of Americans know little or nothing about exchanges, while 40 percent erroneously think reforms create a government panel to make end-of-life decisions for people on Medicare.

An April survey of 1,003 people by HealthPocket, an online company that helps consumers find insurance, also found that the law's penalty for not buying coverage would not induce most 25-to-34-year-olds or 18-to-24-year-olds to purchase it.


GLITCHES AND BUMPS

Obama this week defended the pace of implementation, telling reporters that the government was working hard to "make sure that we're hitting all the deadlines and the benchmarks" even with the challenge of building the new online exchanges.

"That's still a big, complicated piece of business," Obama said, adding the task was made harder by a dedicated Republican opposition still determined to block the law's implementation.

"Even if we do everything perfectly, there'll still be, you know, glitches and bumps," he said.

The administration is building exchanges in 33 states that are unwilling or unable to do so on their own, and has limited funds for marketing. The remaining 17 states are building their own and have received sizable budgets for outreach.

Among states taking the lead, Vermont has launched radio advertising to raise public awareness. Colorado begins its public outreach this month, while California, Maryland and the District of Columbia will hold off until later in the year.

For the federal exchanges, HHS has a contract worth at least $8 million with public relations firm Weber Shandwick and $54 million to train and pay "navigators," or counselors who will help consumers choose a health plan. It also has a $28 million contract with General Dynamics to set up a call center and will make its Healthcare.gov website consumer-oriented.

The administration is seeking help from major U.S. insurance providers to market aggressively to consumers on the federally run exchanges and help convince healthy citizens between 26 to 45 to pay for insurance instead of a first-year penalty amounting to $95 per person or 1 percent of household income.


BLOWING UP

But reform advocates worry that the HHS budget is too small and the spigot for new funding from Congress is shut off by partisan politics. The "navigator" program allocates just $600,000 each for 13 states including Delaware, Iowa, Kansas and New Hampshire.

"There's a limited amount of money that should be increased. But that's subject to appropriations and Congress is not likely to appropriate additional money," said Ron Pollack of the advocacy group Families USA. "It's going to require a very robust effort in the private sector."

Analysts say reform could be as big an issue in next year's congressional midterm elections as it was in 2010, when dislike for the law among senior citizens helped install a Republican majority in the House of Representatives. This time, failed implementation could end Democratic hopes of recapturing the House and leave enough Senate Democrats vulnerable to give Republicans an edge in that chamber.

"We have to see how bad it is. This issue blowing up on Democrats would make the Republicans' job a lot easier," said Jennifer Duffy of the Cook Political Report.

But Democrats believe implementation will also provide favorable coverage of deserving individuals and families finally being able to secure adequate and affordable health coverage after a long sojourn through the current marketplace.

There has been encouraging news for consumers. Vermont says 2014 premium rates will save money for residents. A family of four with an annual income of $75,000 would pay less than $600 per month for coverage with a federal subsidy, versus $900 for the cheapest small group plan available today.

Also on HuffPost:

Loading Slideshow...
  • 1912

    Former President Theodore Roosevelt champions national health insurance as he unsuccessfully tries to ride his progressive Bull Moose Party back to the White House. (Photo by Topical Press Agency/Getty Images)

  • 1935

    President Franklin D. Roosevelt favors creating national health insurance amid the Great Depression but decides to push for Social Security first. (Photo by Keystone/Getty Images)

  • 1942

    Roosevelt establishes wage and price controls during World War II. Businesses can't attract workers with higher pay so they compete through added benefits, including health insurance, which grows into a workplace perk. (Photo by Hulton Archive/Getty Images)

  • 1945

    President Harry Truman calls on Congress to create a national insurance program for those who pay voluntary fees. The American Medical Association denounces the idea as "socialized medicine" and it goes nowhere. (Photo by Keystone/Getty Images)

  • 1960

    John F. Kennedy makes health care a major campaign issue but as president can't get a plan for the elderly through Congress. (Photo by Keystone/Getty Images)

  • 1965

    President Lyndon B. Johnson's legendary arm-twisting and a Congress dominated by his fellow Democrats lead to creation of two landmark government health programs: Medicare for the elderly and Medicaid for the poor. (AFP/AFP/Getty Images)

  • 1974

    President Richard Nixon wants to require employers to cover their workers and create federal subsidies to help everyone else buy private insurance. The Watergate scandal intervenes. (Photo by Keystone/Getty Images)

  • 1976

    President Jimmy Carter pushes a mandatory national health plan, but economic recession helps push it aside. (Photo by Central Press/Getty Images)

  • 1986

    President Ronald Reagan signs COBRA, a requirement that employers let former workers stay on the company health plan for 18 months after leaving a job, with workers bearing the cost. (MIKE SARGENT/AFP/Getty Images)

  • 1988

    Congress expands Medicare by adding a prescription drug benefit and catastrophic care coverage. It doesn't last long. Barraged by protests from older Americans upset about paying a tax to finance the additional coverage, Congress repeals the law the next year. (TIM SLOAN/AFP/Getty Images)

  • 1993

    President Bill Clinton puts first lady Hillary Rodham Clinton in charge of developing what becomes a 1,300-page plan for universal coverage. It requires businesses to cover their workers and mandates that everyone have health insurance. The plan meets Republican opposition, divides Democrats and comes under a firestorm of lobbying from businesses and the health care industry. It dies in the Senate. (PAUL J. RICHARDS/AFP/Getty Images)

  • 1997

    Clinton signs bipartisan legislation creating a state-federal program to provide coverage for millions of children in families of modest means whose incomes are too high to qualify for Medicaid. (JAMAL A. WILSON/AFP/Getty Images)

  • 2003

    President George W. Bush persuades Congress to add prescription drug coverage to Medicare in a major expansion of the program for older people. (STEPHEN JAFFE/AFP/Getty Images)

  • 2008

    Hillary Rodham Clinton promotes a sweeping health care plan in her bid for the Democratic presidential nomination. She loses to Obama, who has a less comprehensive plan. (PAUL RICHARDS/AFP/Getty Images)

  • 2009

    President Barack Obama and the Democratic-controlled Congress spend an intense year ironing out legislation to require most companies to cover their workers; mandate that everyone have coverage or pay a fine; require insurance companies to accept all comers, regardless of any pre-existing conditions; and assist people who can't afford insurance. (Alex Wong/Getty Images)

  • 2010

    With no Republican support, Congress passes the measure, designed to extend health care coverage to more than 30 million uninsured people. Republican opponents scorned the law as "Obamacare." (Mark Wilson/Getty Images)

  • 2012

    On a campaign tour in the Midwest, Obama himself embraces the term "Obamacare" and says the law shows "I do care." (BRENDAN SMIALOWSKI/AFP/Getty Images)