It’s crunch time for Tyler Menges and Ranisha Sampson. Armed with stacks of handouts about the Affordable Care Act, they are going door to door in Kansas City’s urban neighborhoods asking people whether they are interested in enrolling in ACA health plans.
Menges and Sampson know what they’re up against:
Thousands of people still haven’t enrolled — many of them don’t even know yet that they need to. And the March 31 deadline for open enrollment in marketplace health plans this year is just eight days away. After that date, many people who don’t have health coverage will face tax penalties.
Similar enrollment campaigns are underway across the country featuring such tactics as canvassers, health fairs, commercials and phone banks.
Enrollment in health plans through the federal exchanges reached more than 5 million as of a week ago, the Department of Health and Human Services announced. That puts the program within striking distance of the government’s goal of 6 million enrolled by the deadline.
How well ACA enrollment campaigns succeed in these final days will be crucial not only for gaining coverage for the nation’s uninsured this year. It also will set the stage for the continuing acrimonious political debate over the law.
On a sunny afternoon last week, Menges and Sampson were knocking on dozens of doors in a modest Kansas City, Kan., neighborhood off Southwest Boulevard. They are part of a team of 16 canvassers working for CoverKC, a $700,000 campaign sponsored by the Health Care Foundation of Greater Kansas City.
Using the kind of sophisticated data crunching that has revolutionized political campaigns, the foundation pinpointed 68,000 households in the urban cores of Kansas City and Kansas City, Kan., that are most likely to be uninsured. Many of the people living there are young or Hispanic or work low-wage jobs, people who often have little or no experience buying health insurance.
More often than not, no one is home when the canvassers knock. When they do get a response, it’s often been like that of Shawn Dickens.
“What is the marketplace, anyway?” Dickens, 35, asked Menges. Dickens works for a furniture store that offers health insurance, but it costs more than he can afford, he said.
“I’ve never paid for health insurance, ever,” Dickens said. The times he has been covered, it was through his parents and later by the Navy, when he was on active duty.
Menges explained that low- and middle-income people who enroll in marketplace plans often are eligible for tax subsidies that lower their premiums.
“Ah, cool, cool. I’d like to check this out,” Dickens said. “I’ve never been sick, never been to the hospital, but I’m getting older. Things happen.”
Menges said he was amazed at the beginning.
“Even when we mentioned Obamacare, people would say, ‘What are you talking about?’ ” he said.
This lack of awareness of the basic provisions of the ACA is common, particularly among the uninsured who would benefit most from them.
The nonpartisan Henry J. Kaiser Family Foundation, which tracks public attitudes toward the ACA, reported last month that nearly two-thirds of the uninsured said they knew little or nothing about the ACA’s marketplaces. Just 24 percent were aware of the March deadline to sign up for coverage and avoid paying a penalty.
To get this message through, the CoverKC campaign has been bombarding its targeted households with multiple mailings and even recorded phone calls from the mayors of Kansas City and Kansas City, Kan., Sly James and Mark Holland.
In the past few weeks, awareness of the ACA has picked up, said Jessica Hembree, a Health Care Foundation policy officer. People are interested in getting insurance but have lots of questions.
The canvassers have referred about 2,300 people to counselors who have had federally approved training like those with Enroll Wyandotte, a coalition of several local organizations.
Stationed at computer cubicles in an office of the Wyandotte County Public Health Department, the counselors, many of them student volunteers from the University of Kansas Medical Center, go through the enrollment process with as many as eight people a day. It can take anywhere from 45 minutes to a couple of hours for a large family.
“The process is not complicated, but people don’t know about insurance or the ACA,” said Lucia Jones, who coordinates the enrollments. “The complicated part is we have to explain to them how it works.”
After working with one of Jones’ counselors last week, Oralia Gonzalez-Moreno of Kansas City, Kan., came out smiling. The 56-year-old factory worker now has health insurance for the first time and with the tax subsidy, she will pay a monthly premium of about $4.
She wanted to tell other people in her neighborhood about her experience. “They’re afraid, they think it’s very expensive,” she said. When open enrollment in exchange plans began Oct. 1, it was severely handicapped by the malfunctioning website, HealthCare.gov. The site, which took a couple of months to repair, gave ACA opponents ample political fodder. And it slowed the efforts of enrollment campaigns.
CoverKC waited until January to send all its canvassers door to door.
“We didn’t want to drive traffic to a website that didn’t work,” said Hembree.
Enrollment in Kansas and Missouri has faced other, home-grown, hurdles as well. Enrollment, so far, in exchange health plans has lagged in the two states.
According to data crunched by the Kaiser foundation, as of March 1, a little more than 74,000 people in Missouri had signed up for plans. That’s about 11.3 percent of the potential number of enrollees. In Kansas, just over 29,000 had enrolled, about 9.8 percent of the potential number. Nationwide, 14.8 percent of potential enrollees had signed up for plans.
In Missouri, state laws have thrown up obstacles to enrollment.
Last year, Missouri passed a law requiring that federally accredited ACA counselors obtain an additional state license. That law was in effect for a time but now is tied up in federal court. What has been an even greater hindrance to enrollment in the state is another anti-ACA measure called Proposition E, said Ryan Barker, vice president for health policy at the Missouri Foundation for Health.
The law, approved by Missouri voters in 2012, forbids government agencies and employees from providing any resources or assistance to the federal health insurance exchange.
So while Kansas Insurance Commissioner Sandy Praeger toured the state last fall to answer people’s questions and placed extensive information about the ACA on her department’s website, the Missouri Insurance Department has not been offering such help.
“Proposition E has a huge impact on awareness,” Barker said. “It really has been left up to the grass-roots community effort.”
The Missouri Foundation for Health spearheaded the creation of the statewide Cover Missouri Coalition that now has more than 400 members, including organizations and individuals. Last year, it gave out $5 million in grants to organizations to have their employees and volunteers trained as application counselors. It also budgeted $1.2 million for an awareness campaign, using radio and YouTube ads and social media like Facebook and Twitter to reach residents in rural areas.
In Kansas, misinformation and the state’s prevailing political attitudes have dampened enrollment, ACA proponents said.
“We’re hitting the ground as hard as we can to get the word out,” said Katrina McGivern of the Kansas Association for the Medically Underserved, which received a federal grant to promote ACA enrollment. KAMU has been running radio advertisements statewide and has put up a dozen billboards this month on highways. “Unfortunately, there’s a lot of misinformation out there.”
Sheldon Weisgrau, director of the Topeka-based Health Reform Resource Project, has been traveling around the state explaining the ACA at local venues such as Rotary Clubs and chambers of commerce.
“The environment is very hostile, very toxic,” Weisgrau said. Some of the questions Weisgrau has been confronted with: Is it true that insurance plan enrollees have tracking chips implanted in their neck? Is aspirin the only pain relief hospitals can offer patients in an ACA plan? Do senior citizens lose their health care when they turn 75? Are Muslims exempt from the law?
“Some people come in spitting nails,” Weisgrau said. “But I found people’s anger about the law tends to lessen when they understand it.”
Communities Creating Opportunity is holding an Affordable Care Act enrollment fair today at 12:30 p.m. at Second Baptist Church, 3620 E. 39th St., Kansas City.