Thread: Florida overcomes GOP barriers to enroll 440,000 uninsured

Florida overcomes GOP barriers to enroll uninsured

Posted: Wednesday, March 26, 2014 11:34 am
Associated Press |

MIAMI (AP) — Florida's Republican leaders have fought the Affordable Care Act at every turn, banning navigators from county health departments, offering no state dollars to boost outreach efforts to 3.5 million uninsured and leading the fight to repeal the law. Yet the state has emerged as a tale of what went right with President Barack Obama's health care overhaul.

More than 440,000 Florida residents had been enrolled through the federal marketplace through the end of February, putting Florida on pace to exceed the federal government's initial projections by the time enrollment closes March 31.

The numbers are impressive for a state where Republicans control the governor's mansion and both houses of the Legislature. By comparison, Republican-leaning Texas has enrolled 295,000 through the federal site, even though its population is about a third larger than Florida's.

Florida's success is due partly to infrastructure created in the swing state by Democratic-affiliated groups during the last three presidential elections, along with continued investment by the Obama administration and nonprofit advocacy groups in the diverse state that will likely be competitive in November's midterm election.

Groups helping customers enroll in ACA-related health plans have used many of the same people who ran Obama's presidential campaigns, giving them five years of deeply-entrenched relationships in communities, data to pinpoint the uninsured and veteran volunteers to track them down. The state narrowly went for Obama in 2012.

The successes and failures of the Affordable Care Act also carry more political weight in a battleground state such as Florida where the new law will fuel election campaigns for both Republicans and Democrats, said Democratic strategist Screven Watson.

"(The Republicans) are going to use Obamacare as a hammer over the Democratic candidates in November," he said, adding that if Florida's enrollment numbers were dismal, it could have big implications in 2016.

"When you're talking presidential elections, if you have Florida you win," he said.

Florida's Republican leaders chose not to spend any state money marketing the new health plans to millions of uninsured, so the work was supported by $20.5 million in federal grants plus manpower from the nonprofit organization Enroll America.

Florida residents have also been reached by federally funded TV, radio and digital ads. About $52 million has been spent in the last three month on the ads in Florida and the other 28 states relying on the federal marketplace, said Julie Bataille, spokeswoman for the Centers for Medicare and Medicaid Services. The agency has repeatedly declined to provide a state-by-state breakdown of how taxpayer dollars are being spent on ads.

Enroll America's Tony Penna began in 2008 as a volunteer neighborhood team leader for Obama's campaign in Jacksonville, manning three phone banks a night. By 2012, he was a paid organizer for the campaign, overseeing neighborhood leaders and volunteers as they canvassed apartment buildings, staffed tables at community events and made nightly cold calls.

Penna is using those same strategies in his role now as field director for Enroll America overseeing Jacksonville, Tallahassee and Gainesville.

"It helped me build those relationships with volunteers and keep them constantly motivated," said Penna, who estimates about half the volunteers have campaign experience. "It's a longer-term goal because it's a longer term process ... they want to know what the effect of their work really is."

Elsewhere, enrollment results have been mixed in other states that were closely contested in the 2012 presidential election and now rely on the federal exchange. North Carolina has already beaten the initial federal projections for enrollment by the end of March, while Virginia and Wisconsin appear on track to meet the projection. Ohio is falling short of projections.

Enroll America is active in 11 states including Texas, Arizona and Georgia. But the group has claimed a stronghold in Florida, with 40 staff and nearly 5,000 volunteers compared to 38 staff and about 3,000 volunteers in Texas.

Florida's largest navigator grant, $4.2 million, went to the University of South Florida, which hired about 100 navigators, many of whom have years of experience enrolling people in Medicaid and a program that provides health insurance to children from low-income families.

"They have the relationships. They're already trusted as credible sources of information about health coverage," said Jodi Ray, who oversees the USF program. "That makes a big difference."

Instead of creating new programs, USF expanded their staff to help with marketplace enrollment, relying on 10 subcontractors, all with a track record of doing health care outreach, including Florida CHAIN, one of the state's largest health advocacy groups.

"This required constant evaluation of whether the strategies were effective and successful and adjustments were made in order to fully maximize resources and improve efficiency," said Leah Barber-Heinz, executive director of Florida CHAIN.

While Texas leaders say they struggled to navigate bureaucratic red tape to move funds or make quick, critical decisions to tailor outreach efforts, Florida's main contractors knew they needed to be flexible if they were going to meet the high demand and target it to various demographics.

If that meant finding a way to hire new navigators instead of having the same people travelling long distances for enrollment events, then USF found a way to make it work.

Coalitions in other states are often local or regional, said Anne Filipic, president of Enroll America.

"In Florida, it's statewide and they've been doing it for years," she added.

http://www.brownsvilleherald.com/new...149458b3d.html

Seven states that show just how hard it is to measure Obamacare’s success

• BY JAIME FULLER
• March 21 at 6:30 am

March 23 marks the Affordable Care Act's fourth anniversary, and March 31 marks the deadline for people to sign up for health insurance before fines kick in. That means that people are going to be talking quite a bit about the health care law and how its implementation is going.

The Kaiser Family Foundation has released information about how many people have enrolled in health-care exchanges in each state through March 1. Where people are signing up — and where people aren't — tend to follow an easy political rubric. Out of the entire population eligible to join the health-care exchanges, 15 percent have already signed up, a number likely depressed by the Affordable Care Act's inelegant Internet debut. In conservative states where the exchanges are run by the federal government — 27 in all — only 12 percent of the eligible population has signed up. In the 17 states that built their own exchanges, 20 percent of eligible people signed up.

Even when you break down the state-based exchanges by party, the percentage of the population remains the same. Why are these exchanges signing up more people? Because the health-care law was set up to incentivize states to build their own marketplace by providing additional federal funds to help implement the program.

With more money available to publicize the new health-care insurance program and help people sign up, of course these states are doing better on whole. But, things aren't going smoothly in all the states that are running things on their own. And some of federally facilitated exchanges have had great success in signing up people. In some states where Obamacare has incredibly low approval ratings, people are signing up in extraordinary numbers. In some states where the health-care law is popular, sign-ups are nonexistent.

What gives?
Here's a look at a few states that show how complicated analyzing Obamacare's success can be this early in the game. The law definitely hasn't performed to initial expectations so far, but there's no doubt it's also found success in unanticipated places.

Hisham Uadadeh walks out of Leading Insurance Agency after enrolling in a health insurance plan under the Affordable Care Act on February 13, 2014, in Miami. (Photo by Joe Raedle/Getty Images)

Massachusetts, Maryland, Hawaii and Oregon

These are states where everyone assumed things would work. They're Democratic states with leaders who wanted the Affordable Care Act's rollout to go smoothly. And then their Web sites just wouldn't work.

The woes of these states have dovetailed with those of the federal government's exchange – and in many cases have lasted much, much longer.

Hawaii has had the fewest number of sign-ups in the whole nation — 4,661 — mostly due to extended technical problems and little interest from small businesses. Because so few people are enrolled, the state isn't sure it will be able to pay for the exchange when the hundreds of millions of federal dollars run out in 2016.

Maryland has only signed up 9.1 percent of their eligible exchangers, and has hired 200 additional people to work the phone lines because the Web site still doesn't work quite right. The phone lines are always busy, and the wait has frustrated many potential customers. They fired the contractor that built their Web site in late February, and might end up scrapping the site completely.

Massachusetts' Web site is also not working well, and is unlikely to be fixed by March 31. The state has the smallest percentage of sign-ups in the country.

Wonkblog called Oregon's Web site the "nation's worst Obamacare site" yesterday. They just completed a $228,000 review of their technology, and are trying to figure out what to do next. Joining the federally-run HealthCare.gov is an option.

There are many state-run exchanges that have been far more successful. California and New York — which have two of the largest uninsured populations — have together signed up over 1.1 million people. Idaho has the fifth highest percentage of sign-ups by eligible population, although only 36 percent of its residents have a favorable opinion of Obamacare. The state has held over 100 meetings and sign-up events. Vermont, which has a state-based exchange, has signed up 54 percent of its population.

North Carolina

The conservative state government of North Carolina decided not to build a state-run exchange — which would usually mean a small number of sign-ups, if you were to look at most of the states that followed the same course. But North Carolina, Maine and Florida have managed to sign up a significant number of people — when adjusting for the across- the-board decreased standards following the messy November rollout — despite the fact the state government hasn't been as aggressive in pushing sign-ups as states running their own exchanges. In North Carolina and Florida, the number of sign-ups looks promising to the Obama administration since they are two of the ten states with the highest number of uninsured residents. If the Obama administration's last-minute advertising blitz in these states — which also include California, Texas, New York, Georgia, Illinois, Ohio, Pennsylvania and New Jersey — they will get the national tally of sign-ups to go up considerably, too. And that national number is the one everyone will be looking at to give the Affordable Care Act the first semester grades that will define it for November elections.

Texas — where one in four people are uninsured — is likely a lost cause for sign-ups in the near future. The state passed laws this January that makes it difficult to become a navigator, the people who walk enrolees through the complicated sign-up process. Only 39 percent of Texas residents have a favorable opinion of Obamacare.

Conservative candidates who have been all over television commercials the past few months have focused much of their attention on the law.

In North Carolina, Obamacare has a 38 percent approval rating. The state has managed to sign up twice as much of its uninsured population for health care — enough to make them surpass their target number of enrollees. What's the difference? Many groups in North Carolina have been aggressive about hosting events and getting people to sign up. Get Covered America has been there since the middle of 2013, and the Council on Aging has held over 20 events in the past two weeks alone.

Maine, which also uses HealthCare.gov, has had 20.8 percent of their uninsured residents sign up for Obamacare, and has surpassed their target. A nonprofit, Maine Health Access Foundation, has spent $2 million on education and sign-up efforts. Western Maine Community Action, Fishing Partnership Support Services and the Maine Lobstermen’s Association have also led big education pushes. The state House of Representatives has also passed a bill to expand Medicaid, but it is unlikely to survive a veto from Republican Gov. Paul LePage

Kentucky

In Kentucky, only 32 percent of residents approve of the Affordable Care Act, but the state has also been a successful model for how to educate residents about their insurance options and get people to sign-up. Approximately 18.2 percent of uninsured residents in Kentucky have signed up so far. Kansas, which has a similar number of uninsured people and similar approval rating for Obamacare, has only signed up 9.8 percent of its eligible enrollees so far.

Kentucky has been getting national attention as a place that was trying to make Affordable Care Act work for awhile. The state's governor, Steve Beshear, is a Democrat, and mostly responsible for Kentucky's adoption of a state-based exchange and the Medicaid expansion, made optional by the Supreme Court's decision on the Affordable Care Act in June 2012. Republican lawmakers in the state were not pleased with either move, and now seek to limit the executive power a Kentucky governor can wield. Jennifer Tolbert at the Kaiser Family Foundation told the Lexington Herald-Leader in February, "Some of the states we thought were leader states have really run into some significant problems. I think the general sense is that Kentucky has done a really good job of identifying people and getting them enrolled."

Though Web site troubles have gotten attention nationally, the level a state has invested in education and in-person sign-ups seems to be one of the greatest determinants of success for many states.

Michigan

Gov. Rick Snyder was in favor of setting up a state-based health-care exchange in Michigan, but couldn't without the approval of the legislature — which he didn't have. He then tried to set up a joint federal-state partnership exchange in the state — which has voted for the Democratic presidential candidate since 1992. He also couldn't get legislative approval for that, and the state lost all chances for federal funding. The state did approve the Medicaid expansion, however, again proving that Obamacare politics don't always refract along party lines.

The state has also been successful in sign-ups, having the eighth highest number of sign-ups by percentage of eligible population. Republican legislators in the state and outside groups like Americans for Prosperity have continued to campaign against the law.

REUTERS/Mike Segar/Files

Who knows how these successes and slip-ups will change in the next years, but it's important to note that there's no one story to tell about the Obamacare rollout, as we learn more data about premiums and sign-ups and Medicaid enrollment in the upcoming months. With such a complex law, there's probably no way we'll know what to make of Obamacare by November. The only thing we have for sure is a crash course in what's working in some states, and what's bombing in others, regardless of whether people like what's happening or not.

With such a confusing portrait, it's especially easy for politicians to spin the law every which way. This election, you're going to hear a million different things about Obamacare, and as the above snapshots show, about half of them could even be right.

http://www.washingtonpost.com/blogs/...ollout-can-be/

. . . Despite all its problems, Cover Oregon has signed up 49,000 people in private coverage, which places it in the middle of the pack for enrollment. But the signup rates undoubtedly would have been much better for the exchange if it had a working Web site. . .

http://www.washingtonpost.com/blogs/...acare-website/

. . . On California’s exchange, CoveredCA.com, more than 50,000 households began the application process on Tuesday alone, said Covered California Executive Director Peter Lee — the most in a single day since the enrollment period opened six months ago. . .

http://www.utsandiego.com/news/2014/...eadline-march/

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