Advertisement

SKIP ADVERTISEMENT

Health Act Embraced in California

LEARNING THE ROPES The Eisner Pediatric and Family Medical Center in Los Angeles, where enrollment specialists advise people on their options under the new health care law.Credit...Monica Almeida/The New York Times

LOS ANGELES — There are radio and television commercials galore, along with Twitter and Facebook posts and scores of highway billboards. There are armies of outreach workers who speak Spanish, Tagalog, Cambodian, Mandarin and Cantonese, all flocking to county fairs, farmers markets, street festivals and back-to-school nights across the state. There are even dinner parties in Latino neighborhoods designed to reach one family at a time.

With enthusiastic backing from state officials and an estimated seven million uninsured, California is a crucial testing ground for the success of President Obama’s health care law.

It is building the country’s largest state-run health insurance exchange and has already expanded Medicaid coverage for the poor. Officials hope that the efforts here will eventually attract more than two million people who are currently uninsured.

And as the exchange, known as Covered California, has begun the painstaking effort to enroll potential customers in the subsidized insurance plans or expanded Medicaid, the public outreach effort here can seem akin to a huge political campaign.

The state is spending $94 million to help local health clinics, community groups and labor unions reach residents — many who have lived without health insurance for years — and have them complete the often bewildering process of signing up for coverage. “It’s going to take a little bit of everyone doing a lot of different things to get this all together,” said Lisa Hubbard, a director at St. John’s Well Child and Family Clinic in South Los Angeles, which has one of the highest rates of uninsured in the country. “We’re really going to have to try anything and everything.”

The Obama administration is heavily invested in California’s success. It has poured more than $910 million into the effort because California’s uninsured represent an estimated 15 percent of those without insurance nationwide. The state and federal efforts here are yielding results. More than 16,000 applications were completed in the first five days, state officials said, covering more than 29,000 people. An additional 27,000 people have begun filling out applications, numbers that “blew the socks off” initial expectations, said Peter Lee, the executive director of Covered California. While the state initially resisted releasing preliminary numbers, Mr. Lee said officials now planned to provide weekly enrollment updates in an effort to counter the “continued drumbeat of doubters and misinformation.”

“You can’t derail something when it has already left the station,” Mr. Lee said Tuesday in a news conference in the state capital, Sacramento. “We are going very strong.”

While the state will collect demographic information from each application, Mr. Lee said it was too early to know what kinds of consumers had enrolled so far. But with most community clinics and local outreach workers still waiting for official approval to begin enrolling people directly, it would appear that only the savviest or most enthusiastic health care consumers are already signing up. While Mr. Lee and other vocal proponents of the health care law liken using the Web site to shopping on eBay, health care officials say the process can make even the most eager consumer feel dizzy with confusion.

Image
GUIDANCE Lorena Prieto counsels clients about the health care law at the Eisner medical center.Credit...Monica Almeida/The New York Times

“People are really enthusiastic, but they are really unsure about what’s in it for them and what they are going to get,” said Nelson Samayoa, an outreach worker at the Eisner Pediatric and Family Medical Center in downtown Los Angeles, which has a waiting list of 200 people who plan to enroll in Covered California. “Even though there is a lot of information out there, it doesn’t mean people can really access and understand it on their own. They need us to explain it to them.”

The state plans to train and certify 20,000 enrollment counselors and 12,000 insurance agents who will be able to explain options to consumers and help them enroll. But so far, just a tiny fraction of those helpers have received official approval, leaving consumers to either sign up on their own through the Web site or state hot line or wait.

The state in some ways had a head start, expanding Medicaid since 2010. Like those at other clinics throughout the state, outreach workers at Eisner and St. John’s helped hundreds of patients enroll in an expanded county-run health insurance plan as part of the Medicaid expansion. Most of those patients will be switched automatically to Medi-Cal, the state-run insurance program, in January.

Many say the most difficult challenge will come in reaching people who earn too much to qualify for Medicaid, but are eligible for subsidies on the exchange. “I’ve looked at it a bit, but to be honest with you I’m just confused,” said Danielle Waldby, 29, a college graduate who now works as a part-time nanny and dog walker. Ms. Waldby suffered a ruptured abdominal abscess last year, and doctors recommended she follow up with a colonoscopy, a procedure that she said would cost her at least $7,000. By chance, Ms. Waldby had an annual exam at the Eisner clinic on the same day the new health care law went into effect and her doctor urged her to meet with an enrollment counselor, who promised to help once approval from the state came through. “I started to look online, but there’s all kinds of jargon I don’t understand.”

Even as they point out the problems, health care providers who have cared for low-income patients for years are reluctant to heap criticism on the state.

“There’s a big cheerleading effort, this is an amazing thing that’s happening, truly historical and truly a change of how we perceive health care,” said Deb Farmer, the president and chief executive of Westside Family Health Center, a community clinic in Santa Monica. “Perhaps things didn’t happen as quickly as they may have because there was so much uncertainty and this is a massive undertaking. The expectations for Oct. 1 were a little unrealistic, to say the least.”

Staff members were unable to attend three-day training programs run by the state for enrollment counselors until mid-September, Ms. Farmer said, making it impossible to actually enroll people last week. As of Monday, just one staff member had received certification from the state. Ms. Farmer said the clinic, like many other local groups, expected to increase its efforts in November. “We’re going to spend this time making sure we understand whatever quirks there are in the system so that once we get going, we know exactly what to do,” she said.

Many of the outreach efforts began months ago. San Diego Alliance for Youth has set up a regular table at several college campuses, aiming to reach young people whom officials see as a vital target. Outreach workers have learned by now not to engage with hecklers who are eager to debate the merits of Obamacare, a term many advocates refrain from using.

“We want to stay away from anything that’s politically partisan; this is a program meant for the general public,” said Sandra Simmer, who is coordinating the outreach work in San Diego. “We get a lot of ‘What does it mean for me?’ kinds of questions that really require a conversation. There’s nothing that can replace the importance of that.”

A version of this article appears in print on  , Section A, Page 12 of the New York edition with the headline: Health Act Embraced Here, Kept at Arm’s Length There: Rallying Behind New Law, California Is a Proving Ground. Order Reprints | Today’s Paper | Subscribe

Advertisement

SKIP ADVERTISEMENT