Inside The Final Sprint To Enroll The Uninsured Under Obamacare


COLUMBUS, OH — It’s a brisk, sunny Saturday morning in Columbus. By all accounts, it’s the kind of rare winter day meant for strolling outside and soaking up some sun. But approximately 80 Franklin County residents are hunkered down in the main hall of the local International Brotherhood of Electrical Workers chapter, staring intently at a Powerpoint presentation.

The lesson plan? How to get as many uninsured Ohioans as possible to sign up for health coverage under the Affordable Care Act.

The Columbus event is one of dozens being held throughout the country. Run by the nonprofit group Get Covered America (GCA), it’s the last major information session for over 1,500 volunteers before this year’s March 31 deadline for enrolling in health coverage through Obamacare’s marketplaces.

Volunteers are clearly eager to get to work, and the atmosphere isn’t unlike that of a presidential campaign. “I’m excited today — and you can already tell that!” exclaimed special guest speaker city Councilman Hearcel F. Craig (D) to raucous applause. “And we’re gonna sign up everybody we can!”

A five-week race

In Franklin County, there are about 170,000 uninsured folks.

Those attending the session certainly have their work cut out for them. “This is our big, final 37-day sprint, so [we are] beating the pavement as much as possible, getting people the information that they need,” said Matt Caffrey, special projects director for the local branch of Get Covered America. “There are one-and-a-quarter million uninsured Ohioans, and in Franklin County, there are about 170,000 uninsured folks. We want to make sure that as many of them as possible get the information that they need.”


That’s easier said than done. After all, as Caffrey puts it, there isn’t some master list of uninsured Americans that GCA can distribute.

Identifying those who might benefit most from the health law is a painstaking process that involves knocking on doors and reaching out to communities through tabling events at churches, supermarkets, and street corners. Uninsured residents who say they’re interested in more information are then added to call lists so that volunteers can follow up with them and direct them to the right resources for getting covered, such as in-person assisters and enrollment counselors who have the authority to help them sign up for plans.

And the work doesn’t necessarily end this spring. The lawmakers who wrote the Affordable Care Act always expected the enrollment campaign to be a long, hard slog. In fact, the Congressional Budget Office (CBO) estimates that approximately six million Americans will sign up for plans in the ACA marketplaces in 2014 — a number that will gradually rise to 24 million over the next decade.

Obamacare’s worst enemy

Getting people more information about health reform is critical to convincing them to enroll. GCA staff and volunteers alike agree that the number one challenge to signing up the uninsured for new policies is a pervasive lack of public knowledge about the Affordable Care Act.


“We have some numbers that say that 70 percent of people don’t know that the financial assistance exists that they’d be eligible for,” said Caffrey. “But in Ohio, 81 percent of applicants have already been approved for financial assistance of some kind or another. That’s exciting stuff, and we know that if people knew that, the vast majority of them would be very interested in getting coverage.”

GCA’s internal numbers mirror multiple surveys by independent groups like the Kaiser Family Foundation (KFF) and the Robert Wood Johnson Foundation (RWJF), which have found that the uninsured are the least likely to know about the ACA’s consumer protections and financial assistance.

The confusion isn’t strictly limited to the uninsured, either. One woman, a 31-year-old in-person enrollment assister named Ronnita Barksdale, said she didn’t even know about some of the health law’s basic provisions until she went through an intensive certification course allowing her to assist people in the enrollment process.

People were just so hungry for information.

The key to changing that dynamic over the next five weeks, according to GCA, is persistence and a personal touch. The people who have had multiple conversations with GCA volunteers and staff — especially those who get personalized information about federal subsidies that they may be eligible for — are far more likely to enroll in a plan. Those who have spoken with the organization four to six times are twice as likely to sign up for insurance, compared to those who were contacted just once.

“They are so floored that we are following to up to make sure that they got signed up and they are very grateful of that,” said Jean Wentzel, a 64-year-old volunteer.


Another way that the group has been disseminating information is by teaming up with local TV stations to host phone-a-thons where people can call in and ask questions about Obamacare.

“Our phones just didn’t stop ringing,” said 72-year-old Pat Lowenstein. “And we were really backed up from the time the phones opened until we were done. People were just so hungry for information.”

The plan for March

Over the next five weeks, GCA is planning to ramp up the number of phone banks to reconnect with uninsured Americans, hold tabling and canvassing events at churches and community centers, and spread the word about round-the-clock enrollment centers where people can go to have certified counselors help them pick out a plan.

“We’re now going to have enrollment assistants at our offices up on 161st Street five days a week — Monday through Thursday and Saturday, which is great, including evening appointments,” said Caffrey. “And we’ve just got a lot of opportunities to help folks get connected to coverage in these last 37 days. We’re really excited about it.”

The personal assistance aspect may prove critical, as GCA has found that consumers who connect with an in-person enrollment counselor are twice as likely to enroll a plan compared to those who are simply directed to visit The impending March 31 deadline is also likely to be a major motivating factor judging by past experience with Massachusetts’ own health care law and the spike in Obamacare marketplace enrollments before the deadline for coverage taking effect on New Year’s Day.

Why they do it

I’m doing something about the things that frustrated me for so many years.

Saturday’s nationwide training events attracted more than 1,500 volunteers who committed to a grand total of 4,000 outreach shifts in states that are typically hostile to the ACA, such as Georgia, Texas, and Florida, according to GCA national communications director Jessica Barba Brown.

But what attracts these people — many of them retired and elderly — to do such arduous work? Most say it’s personal.

“It’s important to me because I worked in health care, and many of the people that I worked with did not have insurance, or they had insurance that was very difficult for them to navigate,” said Lowenstein. “And also it didn’t cover mental health sometimes… I’m doing something about the things that frustrated me for so many years and that hopefully other people won’t have to deal with.”

Brown recounted a story about an experience she had when working for a public health organization called Cancer Care in New York City. “One day I got a call transferred to my office that was meant for the social work department but somehow got transferred to me,” said Brown. “And this woman on the phone said, ‘I have just been diagnosed with leukemia, I need a bone marrow transplant, I have no health insurance, it’s gonna cost me a hundred and fifty thousand dollars.’”

“And I could hear the fear in her voice, and I could hear the anguish in her voice, and she’s like, ‘What do I do?’”

Some of the GCA volunteers say that people have simply grown cynical about the government’s potential to help them. “They forget Uncle Sam was a benevolent person,” noted one attendant, a 61-year-old man with Parkinson’s.

But over the next five weeks, a few dozen volunteers in Columbus plan to do their best to remind them.