Inside the race to get 6 million uninsured under Obamacare

The best analogy to the Obamacare process is filing your taxes: some people can file online in less than 30 minutes, while some have major challenges that require help from an expert.  It just generally takes an hour to enroll someone, the navigators say.  The website still goes down on occasion, as I witnessed during one enrollment event in Houston, where frustrated navigators  told several people that they can’t finish enrolling them. Some folks don’t like to talk about how much they make. The challenges go on and on.

We’ve moved away from not talking about the fine”

One component you won’t hear about from the President or LeBron James or any of the celebrities enlisted to tout the plan:  the penalty for not getting coverage. (While the rules are complicated, it’s generally $95 for each uninsured adult in a family or 1 percent of their family income, whichever is higher).

And in truth, as Republicans have noted, the administration has created enough loopholes in the mandate that millions can qualify for various exemptions and not pay it.

But on this front, the Obama administration has a smart strategy: let others talk about the sticks while the White House touts the carrots.  The media coverage, from Fox News to local newspapers, has been intense around the fine for not having insurance, but most people don’t know about all the exemptions.

“Everyone knows about it,” one administration official told me when I asked about the mandate and why it wasn’t featured in more of Obama’s speeches.

The Obama administration is banking the benefits of the mandate (it is motivating people to get insurance) without having to incur the cost of having the president go around the country and talk about how he is going to tax people.

But, as the deadline approaches, the people between Obama and the uninsured, community leaders, pastors and liberal organizers, have no qualms about talking about the mandate. They say after five months unsuccessfully trying to get some people to buy insurance, that blunt message is the best.

“We have moved away from not talking about it,” said Samantha Gongora of Enroll America in Houston, who said in the early months of open enrollment that the group had shied away from mentioning the mandate. She added, “telling people there will be a fine on March 31 is a motivator.”

“Amazing”

Al Ortiz, the communications director for the Texas Organizing Project, was busy on Sunday. But he wasn’t  looking to enroll people ­– rather, he was looking for people who can’t enroll.

Texas is one of the 25 states that so far have opted against expanding their Medicaid programs under the law. This leaves out an estimated one million Texans who would be eligible for Medicaid otherwise. In this way, Gov. Perry is the biggest and most important Obamacare opponent in the country. (In Kentucky, a state that has expanded Medicaid under the ACA, 222,000 people have enrolled because its new rules cover virtually all low-income people, versus only 94,000 in Texas, even though Texas has six times the population.)

Groups such as TOP hope to find those folks, hand them to reporters and try to shame Gov. Perry and Texas legislators to change their mind. “We are trying to put a face to the one million Texans who don’t qualify,” Ortiz said.

In the midst our conversation, another TOP staffer approached Ortiz and said he found a woman with a story to tell.

The three of us went to talk to Maria Gonzales. But she then explained in Spanish that she had actually been able to enroll in health insurance. I asked her “why did you wait till the last minute to enroll?”

“I don’t know,” she said.

I then asked what she thought of the insurance.

“Amazing,” she said.

She then recited the price, very precisely: $19.64 per month.

“The Gold Card”

Salazar, the man whose aunt had been denied insurance, brought his wife to a YMCA to get help enrolling. In a room where yoga classes usually meet, four of the navigators were set up with their computers, seated far enough apart that if they spoke softly, no one could hear anyone else’s conversation, to preserve privacy.

Salazar, who says he does not work in part because of injuries to his leg and arm, came with dozens of papers that included his family’s tax returns for the last several years.

Then, he and his wife, who works as a maid, sat down and started talking to one of the navigators in Spanish. For about two hours, the navigator walked them through the enrollment process, with Salazar and his wife interjecting at times with information for the navigator to type in. At one point, Salazar got up to get more documents from his car.

“My goodness, this is unbelievable,” he told me, referring to how long the process was taking.

After a third hour, after being moved to a different conference room at the YMCA, Salazar and his wife got up to leave. They looked angry.

The navigator had told them, Salazar said, that their family income of $16,000 for a family of seven (Salazar has five children) would have qualified them for Medicaid if Texas had chosen to expand its program, but they are not eligible under the state’s current guidelines. Salazar and his wife do not make enough money for subsidies, so the cheapest insurance plan would cost them $400 per month.

“I’m shocked,” Salazar said. “I came here with a lot of enthusiasm that I was going to qualify. I’m very shocked.”

He said, for $400 a month, his family would have to choose between paying for food and getting insurance.

So Salazar said he and his wife would instead just stick with the “Gold Card,” a system in Houston in which low-income people get medical service at clinics on a sliding scale based on income. (Recipients used to receive a yellow-colored card to prove they were in the program, but eligibility is now tracked electronically.)

This system provides health care for low-income people, but Salazar and others say they would rather have insurance, as it can take months to see a specialist and you do not get to choose a personal doctor under the “Gold Card” system.

“We will pay the fine,” Salazar said, although he almost certainly will be exempted from it because of his low income. “I hope in the future, they will figure it out.”

“I haven’t gone to the doctor, but I have to deal with this,” he added referring to the pain in his arm. “Now, I have to wait for the Gold Card.”

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