Despite Obstacles, Local Governments Pursue Obamacare Enrollment

HOUSTON — To coordinate education and outreach efforts associated with the Affordable Care Act, the Houston Department of Health and Human Services is taking an approach that mirrors how the Federal Emergency Management Agency might react to a catastrophe.

The Enroll Gulf Coast initiative has set up an “incident command structure” to synchronize the activities of 13 organizations in Harris and 12 nearby counties.  An “intelligence committee” created heat maps showing the ZIP codes with the region’s highest number of uninsured residents and “access” points, like community centers and libraries, to connect with people in those neighborhoods. Meanwhile, an “operations committee” uses that information to host canvassing and health insurance enrollment events in targeted neighborhoods. The groups also share an online dashboard to input data and track their coordinated enrollment efforts in real time.

“The number of uninsured people that we have here in Harris County, 1.1 million, yeah, that’s a public health emergency,” said Ben Hernandez, deputy assistant director for the Houston Department of Health and Human Services. “That’s why it’s easy for us to say, 'Let’s treat it like we’d treat a hurricane.'" 

While no one believed carrying out the Affordable Care Act in Texas would be easy, a series of additional obstacles has impeded efforts to help the 6.2 million uninsured Texans find health coverage. The launch of the federal marketplace, healthcare.gov, was a technical disaster. The state’s Republican leadership, saying Medicaid is broken, has refused to expand the program for impoverished adults. And last week, the Texas Department of Insurance issued state regulations that added further training and other requirements for the navigators hired and trained by recipients of federal grants to help people enroll in the health marketplace.

Still, government officials and community-based organizations are working together to incorporate new rules, maximize their resources and educate uninsured Texans on how to take advantage of the federal law. 

Will Velazquez, a project coordinator for Bexar County’s Department of Community Resources, is working to unite health care and nonprofit entities in San Antonio to educate the community about the law. “We basically said, ‘How can we serve the community as a whole?’” he said. 

Twice a week, the county reserves 16 computers at BiblioTech, the digital library in San Antonio, and brings in navigators and certified application counselors from five local organizations to assist people with enrollment.

“I need health care right now, so I’m anxious to get in there and see how that’s going to work for me,” said Lisa Guerrero, a part-time clerk in the Bexar County constable office, who visited BiblioTech recently for assistance.

Guerrero has been uninsured for nine years. During that time, she relied on community-health clinics that offer sliding-scale prices for low-income residents.

It can be difficult for low-income families like hers to navigate the health system, because those clinics’ wait times for an appointment with a specialist can range from four to six months, and scheduling follow-up appointments with the same doctor can be nearly impossible. Guerrero said she shared diabetes and blood pressure medication with her father, because appointments are too costly.

“It’s kind of ridiculous that we have to jump through so many hoops to get cough medicine, to get diabetes meds, to get a check-up or a Pap smear,” she said.

Of the 6.2 million uninsured Texans, 28 percent would qualify for tax credits to help them purchase private health plans on the federal marketplace, and 14 percent would qualify for Medicaid coverage, according to the Kaiser Family Foundation.

In addition, more than one million Texas adults — 17 percent of the state’s uninsured population — fall into a coverage gap, according to Kaiser, because the state declined to expand Medicaid to include adults below the federal poverty threshold.

So far, only 118,532 Texans have selected a health plan on the federal marketplace.

Gov. Rick Perry has said expanding Texas’ Medicaid program would cause taxes to “skyrocket” and crush the state’s economy “under the weight of oppressive Medicaid costs.”

In September, he asked the Texas Department of Insurance to enact additional regulations on federal navigators. The regulations were necessary to protect consumers, he said, because the navigators handle sensitive information, such as Social Security numbers, and the federal guidelines were insufficient.

The insurance department issued the regulations Tuesday, requiring federal navigators to undergo background checks and receive an additional 20 hours of state-specific training. Navigators must register with the insurance department by March 1, and complete the additional training by May 1, the end of the six-month enrollment period for the federal marketplace.

“Obamacare presents enough problems for Texans without the risk of a convicted felon handling their personal information,” U.S. Sen. John Cornyn, Republican of Texas, said in a statement. “These are basic requirements for screening individuals hired with taxpayer money to handle sensitive consumer information.”

The federal Department of Health and Human Services awarded $11 million to organizations in Texas to hire and train navigators. They are required to receive 20 to 30 hours of training under federal law.

The United Way of Tarrant County received the largest grant, $5.8 million, and has distributed the money to 17 organizations around the state. There are 165 navigators in that consortium, including 13 hired by the city of Houston. To expand its efforts, Hernandez said the Houston health department has trained 90 city employees to become navigators and expanded their job responsibilities.

The Houston health department is also working with government entities and community-based organizations in Dallas, El Paso, Austin and the Rio Grande Valley to extend Enroll Gulf Coast’s strategy across the state, Hernandez said.

Tim McKinney, the chief executive of United Way of Tarrant County, said navigators within their consortium had conducted 10,000 one-on-one information sessions with Texans, and enrolled 914 people in health plans, as of Dec. 31. 

“The primary mission of a navigator — it’s really not to enroll, it’s to educate and inform,” he said.

Democrats and some health care advocates are critical of the new state rules, saying they are intended to obstruct navigators’ work by adding additional costs and training requirements during the final weeks of the six-month enrollment period.

“It’s really difficult to say that it’s not a politically motivated stunt,” said Tiffany Hogue, statewide campaign coordinator for Texas Organizing Project, political advocacy group for low-income Texans that is working with government entities in Dallas, San Antonio and the Rio Grande Valley to educate Texans on the their insurance options..

The insurance department has said that “unrelated political considerations would be an inappropriate basis for the rules,” and that its intent is to broaden the pool of qualified navigators.