As Obamacare outreach efforts ramp up around the country, the question on everyone’s mind is ‘who will enroll?’ But those who are especially in the know wonder if ‘hard-to reach’ people will even understand that there are programs that they can enroll in.
Seven million California residents are currently uninsured. More than four million will remain uninsured after the implementation of the Affordable Care Act, according to a UC Berkeley-UCLA report released in September, 2012. More than a quarter of those will not qualify for expanded Medicaid or insurance subsidies because of immigration status.
The study estimates that 800,000 of that number would enroll with enhanced outreach efforts. The report predicts that two thirds of the remaining uninsured will be Latino and 62 percent will be based in Los Angeles or other southern California counties. Many of these are lawfully present residents living in “mixed status” families.
LA County took advantage of funding that let them test out the coming expansion of Medi-Cal by enrolling people early. The early expansion is called the Healthy Way LA in Los Angeles. Getting people signed up in advance of the official beginning of the Medi-Cal expansion in 2014 should ensure that fewer people fall through the cracks.
Healthy Way LA has already enrolled more than 250,000 clients and they intend to sign up 50,000 more by January, when enrollees will be transferred to Medi-Cal.
Their enrollment numbers are 12 times higher than the average for other counties. But the most recent estimate from UCLA and UC Berkeley found that there are 390,000 potential Healthy Way LA enrollees.
So the county is taking their enrollment efforts further by going partnering with three community organizations to do outreach.
“We have unsurprisingly found that the most effective way to reach individuals is in their own communities and by groups and individuals trusted in their communities,” said Amy Luftig Viste, Director of Community Partner Programs, Department of Health Services.
“We’ve also confirmed that people are utterly concerned about the Affordable Care Act,” she added.
Gabino Lamas, 49, first heard about Healthy Way LA through an announcement during mass at his church in the San Fernando Valley. Lamas came to the United States from Guadalajara, Mexico 20 years ago seeking economic opportunity. He’s worked construction and at times he’s had employer-sponsored health-care coverage. Now he works independently framing and hanging drywall and can’t afford insurance.
“They wanted to charge me $400 a month for my wife and me,” Lamas said.
Even though they have no major health problems, Lamas and his wife wanted coverage in case of emergency or health problems that might develop.
When his church held an enrollment event in March, he jumped at the chance to sign up. Church members held an educational session the week before enrollment to let their fellow parishioners know what kind of documents would be necessary when they came to the event.
Edward Chavez is an organizer with community group One LA, which hosts enrollment events. He’s even done the eight-hour training necessary to be a certified application assister. He was inspired to get involved after watching his mother suffer with chronic pain and no health insurance.
The organizers scheduled 45-minute appointments for each application at the enrollment event. Some parishioners said they’d given up applying in the past because it usually required taking a day off to sit in a community or county clinic.
When enrollees entered the church they were directed to either a Healthy Way LA, Medi-Cal or community clinic booth.
“Our goal is that everybody leaves with something,” Chavez said.
Healthy Way LA is modeled after the Medicaid expansion and the program has the same income and citizenship requirements. This means undocumented residents and legal permanent residents who’ve been here less than five years don’t qualify.
If individuals do not qualify for a public program because of citizenship status or income, volunteers direct them to community clinics to establish a medical home.
Part of the application assister training is to learn how to communicate in an effective way and put applicants at ease to talk about sensitive information.
At each event the One LA volunteers are enrolling around 100 people in either Healthy Way LA or Medi-Cal. Once enrolled, people like Lamas spread the word to their friends and neighbors about the program.
The county is also partnering with the Service Employees International Union-United Healthcare Workers non-profit organization, We Care Enough To Act, to connect with ‘hard to reach’ residents. Project director Kathy Ochoa said they’re approaching health care the same they would a union organizing project.
“We motivate people to take action in their best self interest,” Ochoa said.
They began doing surveys in targeted neighborhoods in south LA where people were likely to be uninsured and eligible. They found that the biggest obstacle was the cumbersome application process and a general lack of awareness of programs.
In four months, We Care Enough to Act signed up 1,000 people.
They’re using a predictive model they developed during get out the vote campaigns to decide which doors to knock on.
“What we’re finding is of course is when you knock on a door every family member will be in a different circumstance,” Ochoa said. “Maybe there is a grandmother who isn’t eligible by virtue of legal status, mom used to be on Medi-Cal, adult child didn’t realize they’re eligible and father has employee-only coverage.”
The bilingual outreach workers help those families connect with programs they are eligible for and direct others to community clinics to establish medical homes.
“We really see this work as really core to who we are as a union of health-care workers. The Affordable Care Act is really an opportunity to transform the lives of people who are uninsured,” Ochoa said.
They are now working to enroll two thousand people in the Boyle Heights neighborhood. Their model has identified 80,000 eligible residents of the 200,000 people living in the area so Ochoa says they are in this for the long haul.
“The hardest to reach aren’t going to come in until year 3, 4 and 5,” Ochoa said.
Chavez is also committed to this project for the long-term even though he works full time as a sales executive. He sees the bigger picture.
“If it doesn’t work in LA County it’s not going to work anyplace else,” Chavez said. “We are doing this for everybody.”
This article was produced as a project for The California Endowment Health Journalism Fellowships, a program of USC’s Annenberg School of Journalism.