WALDORF, Md. | Two federal lawmakers from Maryland, a state that embraced the new health care law from the start, pitched the benefits of Obamacare to constituents Monday — even as congressional Republicans about 25 miles up the road prepped last-ditch efforts to dismantle the law from their perch on Capitol Hill.
Sen. Benjamin L. Cardin and House Minority Whip Steny H. Hoyer, a congressman whose district sits east and south of the nation's capital, held court with more than two dozen people, many of them health professionals and officials from counties in Southern Maryland who are anxious to see the program work.
The two Democratic lawmakers decried a "dysfunctional" Congress that is sending mixed signals to Americans about the Affordable Care Act and then brainstormed ways to try to get healthy residents to sign up for the state-by-state insurance markets due to open in about two months.
"In particular, it's going to be important to get young people to sign up," Mr. Hoyer said, citing the Obama administration's focus on the 26 to 40 age group.
While many elected officials in Maryland and the nation's capital — both Democratic strongholds — defend the health law as long overdue, those in more conservative states are calling for its repeal.
Conservatives say the law is unaffordable and being implemented unfairly. In the Senate, a group of Republican lawmakers led by Sens. Mike Lee of Utah and Marco Rubio of Florida are threatening to reject any short-term spending deal this September that funds the law.
The Republican-led House will vote on a bill this week that would prohibit the Internal Revenue Service from implementing or enforcing the law.
But even as federal lawmakers battle, local health providers and advocates are grappling with how to explain the labyrinthian law to the uninsured.
"We're learning to ride this bike as we build it," said Michael Shaw, executive director of Calvert Healthcare Solutions, which helps low-income residents in Southern Maryland find health coverage.
Some states are more enthusiastic about the task than others. Only 16 states and the District are opting to run their health exchanges on their own, while 27 have asked the federal government to take on the responsibility and seven will run theirs as a state-federal partnership.
"Many states have cooperated, some have not," Mr. Cardin said after the event in Waldorf. "Some have a mixed record. They maybe voiced opposition but still moved forward to try to get federal funds. There's more confusion out there than there should be."
Federal health officials have shown some regulatory leeway with states that have resisted the health care law, and they're working with private groups behind the scenes to make sure residents in those states understand the law, said Purva Rawal, a senior manager at Avalere, a Washington-based health consulting group.
Looking ahead, she said states that have not embraced the law might not have an enrollment period that is as "robust" as states that got an early start on implementation and promotion of the law.
The Beltway region serves as a microcosm of state-to-state attitudes about Mr. Obama's overhaul. The $3.9 million spent in Virginia to promote the health care law amounts to 49 cents per person, or less than all states except Wisconsin, according to a recent analysis of federal and state sources by The Associated Press.
In the District, though, city officials are enthusiastic. They recently told a packed town hall meeting that they will staff a 24-hour call center at their locally run exchange to help anyone with questions about open enrollment.
"Somebody call me at 3 a.m., or I'll be lonely if you don't," said Purvee Kempf, chief policy adviser for the D.C. Health Benefit Exchange.
In Maryland, Mr. Hoyer said Americans should expect a few stumbles in the early days of implementation.
Attendees at Monday's meeting also wondered aloud if they are doing enough to reach young residents, such as leveraging social media.
"They're not watching the news shows," said Kathleen O'Brien, executive director of Walden Behavioral Health Services. "I don't think what's come out so far has been clear or hit the right audience."
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