California relying on ‘guerrilla’ tactics to sell Obamacare

September 29, 2013 

With baseball’s regular season drawing to a close today, scores of seasonal vendors at Dodger Stadium in Los Angeles and Angel Stadium in Anaheim again are bracing for their health care coverage to end.

But unlike past years – when they would have to wait until Opening Day for their coverage to resume – they’re hearing about another option. Union members are fanning out among the workers who sell peanuts and malts to encourage them to sign up for health care through Covered California. The effort is courtesy of a two-year government grant to the Los Angeles County Federation of Labor, AFL-CIO.

As the state insurance marketplace prepares to open Tuesday, nonprofits, labor unions, social services centers and dozens of other groups are working on a one-on-one basis to persuade the uninsured to buy coverage.

While the state exchange’s glossy, $80 million marketing campaign is expected to permeate millions of homes and workplaces via TV and radio – introducing many to California’s version of federal health care – a parallel effort under way is decidedly grass-roots: Union cooks and housekeepers are chatting up their nonunion counterparts; food and commercial workers are contacting employees of pharmacies and groceries; trade instructors are pulling aside electrical and culinary students.

“People in these industries, they know each other,” said Abby Arnold, project manager for the $1 million Los Angeles County Federation of Labor grant, which pledges to reach nearly 80,000 people across Los Angeles, San Bernardino and Orange counties. “Having the opportunity to have access to a similar level of benefits is really exciting – as long as it’s affordable.”

She added: “They are telling them, ‘This is real. The exchange is opening Oct. 1. You’ll be able to go on and purchase health insurance that will start on Jan. 1.’”

Much of the nation is watching California’s rollout given the size of the state and the fact it has, at 20 percent, one of the highest state rates of uninsured residents. At a stop this summer in San Jose, President Barack Obama held up the Golden State’s online marketplace and the immense machinery behind it as a model, touting its efforts to steer Latinos and other groups with high rates of uninsured toward the exchange.

The uninsured are in many ways more difficult to reach than other consumers, so the state is turning to less-traditional approaches – visiting people in homes, clinics, churches and other places where non-English speakers and the underemployed might congregate.

Covered California has used federal funds to award nearly 50 outreach grants, ranging from $250,000 to $1 million each, totaling $37 million. It also has benefited from $225 million the California Endowment, a private health foundation, is spending to support the Affordable Care Act. Some $130 million of that is going directly to enrollment efforts aimed largely at Latinos. The endowment and other groups have been able to burrow deeply into communities, in one case calling on the aid of a single boxing club in Santa Ana to communicate with members and their families.

“I love that example because it gives you a sense of how guerrilla you have to go,” said Daniel Zingale, a senior vice president with the California Endowment.

Such face-to-face encounters from trusted community organizations go far to help people get their questions answered, said Carmella Gutierrez, president of Californians for Patient Care, a patient-advocacy organization in Sacramento. The law requires most people and their dependents to have health insurance or pay a penalty.

“This is a huge undertaking, and this is where the rubber meets the road,” Gutierrez said. “The ultimate measure will be enrollment numbers, but I do believe this is right approach, because it’s all about the human connection.”

Last week, Covered California Executive Director Peter Lee said the goal is to enroll 487,000 to 696,000 people who are eligible for subsidies by April 1. That jumps to a target range of 840,000 to 1.2 million subsidy-eligible residents by Jan. 1, 2015.

“Those are big numbers. They are big goals,” Lee said. “Our goal is to blow the roof through these estimates.”

Still, he cautioned not to expect many of the newly eligible to come knocking in October.

Through December, Covered California plans to spread the word at 7,300 events, ranging from farmers markets and street festivals to presentations at elementary and high schools. Organizations receiving grants include the Asian Pacific American Legal Center, the California Black Health Network and the Los Angeles Gay and Lesbian Community Services Center.

Fresno Healthy Communities Access Partners, tasked with reaching about 100,000 county residents, is relying on the help of hospitals.

“People are most interested in health insurance when they actually have a need to use it,” Executive Director Norma Forbes said.

The group is targeting uninsured, younger people who speak Hmong, Cambodian and Lao, as well as Latinos and African Americans. One community-based group working with the organization has a standing spot on Spanish-language television.

Despite the group’s reach, Forbes said she expects few people to sign up in the early months of open enrollment. “Come December, the interest will pick up ... January, February, March, there will be a great deal of interest,” she said.

In Alameda County, East Bay Agency for Children is expanding on a model it used to promote food stamps and Medicare. The organization attends Indian festivals and Afghan youth soccer in Fremont, using staff members who themselves have been leery of government-inspired care. The goal is to reach people in 11 non-English languages including Farsi, Dari, Pashto and Hindi.

“What we’re finding is people have a general sense that something is coming, but what we’re learning – as with anything so new – it takes a couple of touches and new interactions to get them to trust, understand and take the next step,” said Julie West, the group’s development director.

The Sacramento Employment and Training Agency, which received $1 million to reach 186,000 people, also has appeared at a range of venues, including Our Lady of the Rosary in Carmichael and the Sacramento Aloha Festival at Cal Expo.

Dan Kitowski, director of health services for the Actors’ Fund Western Region, is reaching out to people in the visual and performing arts and entertainment industries. His focus centers on guild and union meetings, member orientations and recording events. They meet in theaters, public libraries, arts fairs or wherever artists congregate.

Kitowski and others walk participants through an hourlong workshop that touches on the federal health law and delves into the details of the state program: plan options, the enrollment process, and the shop-and-compare link.

At one event, with more than 100 people in attendance, the instructor said he used an online calculator to demonstrate potential insurance rates. When the cost appeared, along with a subsidy, one woman shouted, “That’s not affordable!” She was quieted when someone interjected that the proposed cost was about $300 less a month than he was currently paying, Kitowski said.

“I am pretty energized by all of this, and I feel in a very small way responsible,” he said. “Covered California gave me (a grant for) $435,000, and I have to do something important with that. And I really believe that. We are working our butts off.”

Call Christopher Cadelago, Bee Capitol Bureau, (916) 326-5538. Follow him on Twitter @ccadelago.

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