(Bloomberg) — Republican governors seeking to make their states enemy territory for the Affordable Care Act are facing a counteroffensive. Among the vanguard: two 74-year-old retirees walking the streets of working-class New Jersey.
Margot Lee and Claude Cesard recently went door-to-door to pitch the health law’s benefits. They’re among thousands of supporters mobilized by the nonprofit group Enroll America to encourage the uninsured to sign up for the ACA’s new health plans, one household at a time.
The campaign is relying on tactics honed in Obama’s election victories to promote the law in states where leaders such as New Jersey Governor Chris Christie have shown little support. Low enrollment early on could deal the act a serious blow, raising costs for consumers, bolstering Republican attacks and deepening public skepticism. Success could smooth its path into the future.
“It’s a cause we believe in,” said Lee, a retired attorney, as she canvassed homes last month in Englewood, New Jersey, five miles west of New York City. “Health care in this country is a mess, and this is a step in the right direction.”
Lee got her start in political activism in 1948 at age 10, helping her grandmother hand out fliers for Harry Truman’s election. She registered voters for Obama in 2008 and 2012, and felt compelled to act this year after seeing relatives struggle without insurance, she said.
It’s her job to help counter “the big lie” being pushed by the law’s critics, Lee said.
It won’t be an easy task. In June, the nonprofit Kaiser Family Foundation found 43% of people had an unfavorable view of the law, compared with 35% in support. An April survey by the group, which studies health-care policy, found 40% weren’t even sure the measure was still in effect
“You can’t just turn on the exchanges Oct. 1 and expect people to show up,” says Thomas Buchmueller, a University of Michigan health economist. “For a lot of people, it’s just not on their radar screen.”
Enrollment is scheduled to begin Oct. 1 through new call centers and online exchanges created by the act. As in an election, turnout will be crucial. The Obama administration has estimated about 40% of the new enrollees need to be young and healthy, to offset an older, sicker population expected to flood into the market. Without that balance, premiums may soar.
Enroll America is concentrating its efforts on 10 states, including Texas, Florida and New Jersey, many of them with elected officials who’ve shown little interest in promoting the law. The Washington-based group, led by a former Obama campaign field director, has organized 3,000 volunteers so far. It’s working with local partners, from churches to health clinics to barbershops, to advance the message.
The goal is to contact potential enrollees at least a half-dozen times, said Mimi Garcia, the group’s director in Texas.
“It might be somebody on their doorstep,” Garcia says. “And then they go to church, and their pastor is talking about it. There’s a table with information afterwards at the Sunday social, and then they’re going to CVS and there’s info about it at the pharmacy. It’s all of these different messages that are going to make an impact.”
The effort, like Obama’s political campaigns, is driven by target lists culled from opinion surveys and carefully mined consumer data.
In New Jersey, Christie has vetoed bills seeking to set up a state insurance exchange. That’s put the state among 27 that have refused to run their own markets, instead leaving the work to the Obama administration and its allies.
Lee and Cesard took the pitch to Englewood recently, knocking on doors in a neighborhood of converted bungalows and aging Colonials. They carried maps with red dots showing where the uninsured lived. Color-coded charts explained the law’s new insurance subsidies for consumers.
Their script from Enroll America didn’t mention “Obamacare” or the “Affordable Care Act,” potential red flags in the political war over the health care overhaul. Instead, it stressed the “new health coverage options that will make it easier to afford quality health insurance.”
Lee and Cesard both get their health care through Medicare, the U.S.-funded program for the elderly. Cesard, a retired engineer, said the kind of security he gets from the U.S. plan seems to be drifting away for many Americans.
“I have a plan that works fine for me, but that’s not the case for everyone,” he said. “I’m concerned for the younger people, for my sons and grandsons.”
The pair mostly knocked and found no answers on a sunny Saturday afternoon. Those who did come to the door mirrored the national conversation, offering a mix of confusion, contempt and hope for the law.
Fernando Perez, a construction worker, told the pair his insurer had raised the copay for a medicine he needed by tenfold, to $200. He blamed ‘Obamacare.’
Insurance is “expensive to begin with, and now it’s going to cost even more,” he said afterwards, in an interview with a reporter who accompanied the volunteers.
“If you need to go out and sell it and have a campaign,” he said, “it can’t be that good.”
A few doors away, the canvassers found more support from Diego Arenas, an uninsured truck driver who said he’d been without coverage for “many years.”
Talking across a fence decorated by a tumble of pink roses, Arenas, 50, said he’d suffered with a sore shoulder for more than a year because he couldn’t afford a health plan. When he finally went to a hospital, he left with a Tylenol and a bill for $3,200, he said.
“Every time I need to go to the doctor, I pay $800, $700,” he said. The law sounded like “something good for people in the lower-middle class.”
He smiled politely at the older pair as they handed him a brochure.
“We don’t want everything from the government,” Arenas said. “But a little help, especially in this economy, I think it’s a good idea.”
Aida Cortez, 44, said she, her husband and two young daughters had lost their coverage at the start of the year because of “paperwork problems.” Her solution has been to “take better care of myself, exercise more, eat right,” she said. Still, she worried about her children, she said.
While the health law sounded promising, she hadn’t kept up on the details, Cortez told Lee. Would it be an HMO, or health maintenance organization, the kind of insurance plan that keeps tight reins on the doctors members can visit?
That’d be one option, Lee told her. The law’s tax subsidies, she said, could offer help in affording the plans.
Would ‘Obamacare’ cover everybody in the house?
“It’s for everyone in America,” Lee said.
Lee and Cesard departed, moving slowly in the midday heat and humidity. After two hours, they’d knocked on more than a dozen unanswered doors, found one skeptic, a few supporters and several people, like Cortez, who were unsure about the law’s provisions or confused about its potential effects.
Lee called it a success.
“Anytime you can talk to people who don’t know about the law and give them some information, that’s a success,” she said. “This is just the first step. These people, we’ll be contacting them again.”
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