Inside the race to get 6 million uninsured under Obamacare

HOUSTON – The Obama administration is effectively running another national campaign, but this time with the goal not beating Mitt Romney but getting at least six million people to enroll in plans through the Affordable Care Act by the end of this month.

Houston is normally ignored during the presidential election, because it’s in a deeply red state. But now, liberal groups and Obama administration officials are sending staffers and volunteers into churches, community centers, libraries and YMCA’s all across America’s fourth-largest city, determined to find and enroll some of estimated one million uninsured people who live in this area.

Houston is one of 25 major cities nationwide (Atlanta and Miami are among the others) where a huge swath of America’s uninsured live, and Obamacare supporters are concentrating their efforts almost exclusively on ramping up enrollment in these cities over the next two weeks. Houston and surrounding Harris County has about the same number of people as the state of Kentucky (4.3 million) and it’s a much smaller geographic area than an entire state.

But getting people to enroll in insurance may be harder than getting them to vote for you.

“I thought you couldn’t be denied”

Texas is way behind peer states. Even though 300,000 have enrolled in private insurance plans here, the New York Times reports  that’s around 54 percent of the administration’s target, compared to 84 percent for California, the other state that had more than six million uninsured before ACA enrollment started.

Liberals here and nationally blame this on Texas Gov. Rick Perry, a vocal Obamacare opponent who refused to set up a state-based exchange or expand Medicaid under the ACA. His administration enacted a provision that requires people who assist the uninsured in enrollment (“navigators” in Obamacare parlance) to undergo background checks and be fingerprinted before they can start the job.

But Houston should be more fertile soil. Obama won Harris County in 2012 and  Mayor Annise Parker has heavily promoted the law. The city of Houston has not only hired staffers specifically to help with Obamacare enrollment, but gave Enroll America, a non-profit group staffed by former Obama aides set up to sign up people across the country, an office in the city’s health department.  The mayors of San Antonio and Dallas are also big boosters.

And despite Perry’s opposition, people in Houston are being flooded with messages encouraging them to enroll in Obamacare before the March 31 deadline. The law is being covered on local news extensively.  Telemundo and Univision stations in Houston have had call-in programs for people to ask questions about the health care law. Many people here told me they heard about the law on the radio. The Centers for Medicare and Medicaid (CMS), which formally runs the ACA, is running TV commercials in big cities around the country, including Houston.

“It was on the news several times this morning,” said Annie Singletary, a retired black woman who was at a YMCA on Sunday with her grandson,  referring to Obamacare news.

Singletary said she can’t escape information about the law, even though she’s already on Medicare. Her pastor has brought up the law several times at church, something African-American ministers are doing throughout this area.

“He says ‘this Obamacare is here to help you and anybody who does not have insurance should get it,’” said Singletary.

Still, it’s slow going. After talking to dozens of people here of all ethnic groups and political beliefs, it’s clear the main challenge in Houston is the same as other parts of the country: almost everyone has a bad story about the health care law, or is confused by it.

Some went online in the fall and couldn’t sign up on the broken website and have been reluctant to try again. Others heard horror stories from friends. Many don’t like being required by law to purchase insurance. Another bloc has heard from others that the prices are too high and haven’t bothered to explore themselves.

“I have an aunt and she didn’t qualify,” said Alfredo Salazar, as he waited for a navigator to help him at an ACA enrollment event at the YMCA.  “She was denied. I thought they said you cannot be denied.”

Salazar was referring to one of Obama’s chief selling points for the law: people can’t be denied coverage, as before, because they have illnesses.

Salazar wasn’t exactly sure why his aunt did not get coverage. From his retelling, it was not clear she understood either. And that confusion isn’t helping the law gain support from the public.

“That got me more confused,” he said of his aunt’s experience. That, along with what he had heard about the website, made him decide to wait until Sunday, only two weeks before the end of open enrollment.

“I hope it’s good. I have a bad leg, I haven’t gone to the doctor because I don’t have insurance,” he said.

And many young people here, like in other places, simply aren’t that motivated to get insurance.

“I’m working here, and it took me a while to sign up,” said Jorge Ortiz, who is doing some part-time work for the Houston Area Urban League enrolling people.

 “It’s called procrastination”

The vast majority of Americans who have enrolled in Obamacare did so at home, on their computers, well before the March 31 deadline.

A coalition of pro-ACA groups in Texas and nationally are working on the rest: people who don’t own computers; those, particularly Latinos, who are wary an online government form will expose their own or their relatives’ immigration status; people whose family situations are sufficiently complicated that they have tried to enroll at but failed; people who truly didn’t know about the health care law until recently; and another bloc described best by Ortiz, who told me, “it’s called procrastination.”

One tactic of the pro-ACA groups (Enroll America, Planned Parenthood, the National Urban League and others) is to put on events, particularly in disproportionate low-income, minority parts of Houston where people can bring in their financial information and get personalized counseling.   (Enroll America’s office in Houston includes detailed maps of the city’s uninsured, with zip codes with more than 5,000 people in dark red, and they are trying to have many events in those areas.)

These liberal groups, particularly with only two weeks left in the enrollment process, are largely targeting black and Latino families who truly need health insurance, not the young, healthy men who the White House is focused on to make sure the insurance markets in each state are more balanced by age.

One organizer I talked to specifically mentioned the “Between Two Ferns” video President Obama did last week as an example of the kind of media the people he is trying to enroll don’t  watch.

“A lot of people don’t watch TV, a lot of people don’t read the news, a lot of people don’t know what’s going on,” said Ann Lister, one of the field organizers for Enroll America.   

She can’t count on the crowds of the Obama campaign. She expected just 20 to attend an enrollment seminar at Good Shepherd, an African-American Baptist church. Another liberal group crowed about an event that 300 people attended, a tiny fraction of the people who are uninsured here.

“I’m triple booked,” Lister said, referring to two other ACA events she was hosting last Saturday. “We are all over the place. That’s how we are going to penetrate Houston.”

And this outreach is labor intensive. The 300-person event, held in downtown Houston, required 25 staffers on hand to help people enroll people. Organizers are already talking about the need to hire more staffers, particularly Spanish speakers, for the next round of Obamacare enrollment, which starts in the fall.

“”The challenge Texas has is there are so many people who need that in-person assistance, who have never had health insurance or who have never made a major purchase online,” said Tiffany Hogue, who is running the state healthcare campaign for Texas Organizing Project.

“Email-set up for marketplace”

Last fall, when President Obama compared buying health insurance to buying an airline ticket on, the clunky website undercut that promise.

But he was wrong in two other ways too. Buying health insurance, with the huge set of regulations that comprise Obamacare, is simply more complicated than booking a flight from United. And the president may have forgotten many Americans, particularly elderly and low-income people, don’t purchase airline tickets or anything else online.

Another obstacle: requires an e-mail address. Each day, enrollment navigators encounter many people who don’t have e-mail addresses, or even a computer at home.

For an event in Houston at Baker Ripley, a neighborhood center that mainly serves Latinos, a staffer was designated just to create Google or Yahoo e-mails for people, with a handwritten-sign “EMAIL SETUP FOR MARKETPLACE,” above her head.

“We were spending 20 minutes working with people, just to set up e-mail accounts, before we even started anything,” one of the Enroll America staffers told me. “So we decided to have somebody there just doing that.”