Guerilla Outreach: How Exchanges Are Being Promoted in States Hostile to Obamacare

Aug. 14, 2013 - AIS Health

Guerilla Outreach: How Exchanges Are Being Promoted in States Hostile to Obamacare

By Steve Davis, Managing Editor

The federal government has allocated nearly $700 million to help promote state insurance exchanges, according to data compiled this month by the Associated Press. But some states that oppose the health reform law will receive substantially less funding than states that are operating their own exchanges or partnering with the feds. In states where the governor opposes the health reform law, grassroots advocacy groups, hospitals and health insurers are picking up the slack and reaching out to the uninsured.

According to AP’s research, federal dollars earmarked for outreach will range from a low of 46 cents per person in Wisconsin — a state that will default to the federally facilitated exchange — to as much as $9.23 per person in West Virginia, which opted for a state-partnership exchange.

Few state leaders have been more vocal in their opposition to the health reform law than Texas Gov. Rick Perry (R). While the governor’s office isn’t promoting the state’s exchange, the Texas Dept. of Insurance is offering “general information” to consumers about the exchanges, says spokesperson John Greeley.

More than 6.3 million Texans lack health insurance — a population larger than most states, notes Mimi Garcia, state director for Texas at Enroll America, a non-partisan nonprofit that is working to educate Americans about coverage options made available through the Affordable Care Act (ACA). Texas has received about $8 million in navigator grants and about $10 million in other funds to conduct in-person application assistance — which translates to about $1.44 per state resident.

Groups Try to Build Exchange ‘Buzz’

“About one in four Texans has no health insurance, which means pretty much everyone knows someone — and in many cases someone very close to them — who doesn’t have health insurance,” she tells HEX. “We want to create a ground-base buzz of information and action around enrollment.” Garcia says her office is in a “capacity building stage” and intends to nearly double its staff of 15 by Aug. 5. Two months ago, Garcia was the only employee in the Texas office. The new staff will include four organizing leaders who will oversee field organizers, who will build volunteer teams and work with local organizations and institutions to “amplify their capacity” to reach out to members of the community. A field organizer will oversee as many as six “leadership teams” that will serve as community messengers. And those messengers will build volunteer teams of their own.

Enroll America’s partners include health insurers, hospitals, doctors, pharmaceutical companies, employers, consumer groups, faith-based organizations, civic organizations and philanthropies, according to the group’s website.

Garcia says that facilitating face-to-face conversations between the uninsured and informed members of the community is the most effective way to get the message across. While she says there is some misinformation about the reform law, “more than anything there is a lot of confusion about whether this is happening in Texas,” she says. Her organization is in the process of building relationships and partnerships with hospitals and providers and has had conversations with health insurers, community organizations, municipalities and school districts, she adds.

“The most important person you can hear something from is a close friend. Me showing up on someone’s doorstep explaining this doesn’t mean as much as hearing from someone’s pastor. Or their next door neighbor,” says Garcia.

Louisiana Blues Launches Coalition

In Louisiana, where Gov. Bobby Jindal (R) remains a vocal critic of the reform law, Blue Cross and Blue Shield of Louisiana launched Louisiana Healthcare Education Coalition. The outreach group’s 130 partners include Louisiana AARP, local magazines, state hospital and medical associations, chambers of commerce, food banks, clinics, rotary clubs, church groups and insurance broker associations. In Louisiana, a state with a population of 4.6 million, as many as 400,000 adults lack health coverage.

Along with reaching out to its current members, the Blues plan also is working to educate insurance agents and network providers so that they can answer questions about coverage and premium subsidies. Through two monthly e-newsletters — one aimed at hospital and physician group executives and the other for their staff — the insurer breaks down various components of the ACA provisions and their impact on coverage. The coalition also has a speakers’ bureau. The Blues plan’s senior health care economist has been traveling the state since the ACA was enacted, and has talked with at least 500 community groups, according to spokesperson Robin Mayhall.

Three weeks ago, the Blues plan hosted a webinar for insurance agents and brokers. Mayhall says many people think premiums will soar for individuals once they incorporate the new taxes and fees, mandated essential health benefits and the 3-to-1 age-rating bands. “But if you’re eligible for a subsidy, you could end up with very affordable coverage,” she says. A microsite launched by the insurer lets consumers determine how much of a subsidy they might receive.

Blue Cross Blue Shield of Kansas City operates in two states that opposed the health reform law — Missouri and Kansas. The health insurer launched a “brand-image” campaign early this year that targets current and potential members, including the uninsured. That campaign will pivot to more of a lead-generating direct sales campaign in September, says Wayne Powell, vice president of executive services and chief of staff.

Groups Face Confused Masses

“The population we are trying to connect with isn’t all that engaged. There is a lot of confusion around the ACA,” he tells HEX. “Some people think it was repealed or that there have been changes to the law that may or may not apply to them. They are currently looking at it through a political prism rather than as a real offering.”

Like the Louisiana Blues plan, BCBSKC is partnering with community organizations, such as safety net clinics and media outlets. “There’s no state support, but local not-for-profits and foundations are gearing up to engage the uninsured,” Powell says. The Blues plan, which has about 72,000 individual direct-pay members, estimates that as many as 300,000 people in its service area could qualify for some level of federal premium assistance.

Blues plan operator Highmark Health Services intends to participate in exchanges in West Virginia, Delaware and its home state of Pennsylvania. Highmark recently launched an advertising campaign offering consumers a printed guide to health reform and an informational website. “These are warm-up materials” to follow-up campaigns that will launch closer to the start of open enrollment on Oct. 1, explains Tony Ryzinski, vice president of marketing. Highmark’s 10 retail stores will give individuals and small employees a place to go for face-to-face conversations with a health insurance specialist. Highmark also will partner with national and regional grocery store chains to provide educational materials to consumers. “And we’ve already partnered with H&R Block to help consumers get ready for reform’s changes,” Ryzinski says.

To see Blue Cross and Blue Shield of Louisiana’s health reform microsite, visit www.bcbsla.com/reform. Visit Highmark’s educational sites at www.highmarkonhealthreform.com and http://discoverhighmark.com.