Old-Fashioned Shoe Leather, High-Tech Microtargeting Help Organizers Pave Way For Obamacare

Published on
August 22, 2013
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Six years ago, Terry Uribe’s then-husband lost his job and with that, a family of five lost their health insurance. Uribe, who is 52 and works as an accountant for a small firm, hasn’t had insurance since, and, for the most part, neither have her three children, now aged 17 to 26.

“If I get sick, I just go to whatever clinic is available and is least expensive, or I just wait until it gets better on its own,” Uribe says. “I’m always telling my kids: ‘Don’t get sick. I can’t afford it. I have a 17-year-old who I didn’t let play sports. I said I can’t afford it if you get injured. He wanted to play football.’”

So when a card came in the mail recently inviting her to come to an event to see if she’s eligible for health insurance through the Affordable Care Act—Obamacare, as foe and friend alike now call it—she jumped at the chance. Last Saturday, she and her two daughters, Celeste Moreno, 26, and Jazmin Moreno, 21, lined up at a union hall in East Los Angeles and took the first steps to register.

The event was part of a fevered push, now well underway, to pave the ground for Oct. 1—when people can begin signing up for health insurance—and Jan. 1 2014, when they can start being covered. Uribe and her daughters were among the dozens taking part in “Let’s Get Ready for Obamacare,” an enrollment campaign organized by the Service Employees International Union-United Healthcare Workers of California.

Similar efforts are taking place throughout the country. At a time when critics have stepped up their attacks on the Affordable Care Act—and some in Congress threaten to shut down the government to block it—supporters are gearing up to make the law work.

Enroll America, an organizing effort led by veterans of Barack Obama’s presidential campaigns, is leading the push for enrollment. The group has deployed 90 field organizers in 10 key states to lead the pre-enrollment campaign, a number that will rise to 150 by Oct. 1, said Jessica Barba Brown, the group’s communications director. The group is using census data and micro-targeting technology to identify zip codes and even blocks where people without health insurance are most likely to live.

The Service Employees union is working in nine states, using its field organizers and volunteers to do outreach in communities where the union has strong roots. With Congress in recess this month, the union also is dispatching members to town-hall meetings, where legislators are meeting with constituents, to speak up for health access and take their case to the public.

[video: http://www.youtube.com/watch?v=EFPLF1cyQEo]

No state has done more to prepare for Obamacare than California, where the governor, legislature and civic organizations support the law as a way to provide health care for the estimated 5.3 million residents who were uninsured before it passed. It was the first state to set up an insurance exchange, an online marketplace run by a new state agency called Covered California. Beginning Oct. 1, people can comparison-shop on the exchange and chose from insurance plans offered by 12 insurers selected by the agency from 33 that applied.

Covered California has also awarded millions of dollars in grants and contracts to organizations to do outreach, provide consumer assistance and inform residents about the new insurance options. The agency will also back a media campaign, including commercials, billboards and social media to inform Californians that health insurance options are on their way.

“There’s an air war and a ground war, a marketing campaign as well as working with people and groups on the ground,” said Anthony Wright, executive director of the advocacy group Health Access California. “Some people will go online and sign up for insurance themselves; others will need handholding from trusted community organizations.”

The California Endowment, a statewide foundation that works to expand healthcare access and improve community health, has pledged $225 million to help with these efforts, including advertising by Spanish-language broadcasters and support for grassroots enrollment efforts.

“We are committed to ensuring all Californians have health coverage, and for the first time, Obamacare is making that possible,” said Maricela Rodriguez, program manager at the Endowment. The foundation’s support “will help provide these newly-eligible Californians information about their health care options.”

Endowment funding enabled the Service Employees union to set up a nonprofit organization, We Care Enough to Act, to launch its enrollment campaign targeting low-income neighborhoods of south and East Los Angeles.

“We’ve had enrollment efforts at health clinics, in schools, in housing projects, in the middle of a health fair and during back-to-school backpack giveaways,” said Flannery Hauck, an SEIU organizer who’s directing the Los Angeles enrollment effort.

Union members have also been knocking on doors and talking to neighbors, explaining Obamacare and helping people overcome their fears about applying.

“One of our secret weapons is we’re a union of healthcare workers,” Hauck said. “We have experience talking with people, working with people as patients, talking about sensitive health issues.”

On a recent Saturday morning, potential enrollees began arriving at the hall at 9 a.m. Purple-shirted SEIU staff members and volunteers described the Obamacare program. Enrollment counselors got information from each applicant about their family, job and income status and helped assess their eligibility.

When the event was over, 42 more people had been enrolled into Healthy Way LA, a county program that provides free healthcare to low-income residents at 100 community clinics. That brings to 1914 the number of Angelenos that the union has brought into the program.

Healthy Way LA now has 250,000 members and hopes to reach 300,000 by year’s end, said Michael Wilson, a county health department spokesman. Statewide, more than 700,000 Californians have joined similar county-run programs, with funds provided through the federal health-reform law.

Nearly all should be able to move directly onto Medicaid when the federal health insurance program expands Jan. 1, said Anthony Wright of Health Access.

“That’s the exciting thing,” Wright said. “We will start with 700,000 people enrolled on Day One .”

Some of those who attended the SEIU enrollment event, including Terry Uribe, learned they’d be eligible to purchase subsidized insurance through the state exchange. California is one of 20 states that have chosen to embrace the provision of the health-reform law that opens Medicaid enrollment to people with incomes at or below 138 percent of the federal poverty line. People with higher incomes will be able to buy insurance on their own through Covered California, and many will be eligible for tax credits to help pay for it.

For SEIU, the organizing effort isn’t just about signing people up for insurance. “It’s about keeping people well rather than treating them when they’re chronically ill,” said Hauck. “When people act in support of themselves and their communities it makes a difference in improving their lives.”

This blog originally ran on Forbes.com. For more postings from Rob Waters, click here.