Health & Human Services

Haircuts and Health Care: How Governments Try to Get the Uninsured Covered

States and cities spent this enrollment season finding creative ways to reach the millions who still have no health insurance.
by | December 15, 2015
Dr. Eric Griggs visits a barbershop in New Orleans to invite its staff to join the mayor's Barbershop and Beauty Salon Health-Care Enrollment Challenge. (Office of Mayor Mitch Landrieu)

People only have a few days left to sign up on the Affordable Care Act marketplaces for health coverage that starts in January. Those still uninsured in 2016 will have to pay a hefty tax penalty of $969 on average. To get the roughly 33 million uninsured Americans covered, governments and nonprofits are getting creative.

Take New Orleans, where the city trained beauty and barbershop owners so that they can informatively talk to their customers about getting enrolled in health care. Haircut? Check. Health insurance? Maybe later. The shop that refers the most people to a health insurance enrollment office will get a visit from Mayor Mitch Landrieu.

“Louisiana is at the bottom of almost every health statistic,” said Charlotte Parent, the director of the New Orleans Health Department. “So in my mind, we are just taking all the logical steps necessary to change that.”

The 33 million people who remain uninsured are the most difficult to reach or convince of the need to have health care. Among them, 7 million are thought to be undocumented immigrants, another 7 million are "young invincibles" -- people between the ages of 18 and 34 -- and close to 4 million fall into the "Medicaid gap" -- people who make too much to qualify for government-subsidized health care but not enough to afford private insurance. The rest of the uninsured are likely a combination of these categories.

New Orleans is unique in its approach this year but not in its efforts to find and talk to the uninsured about health care in places they feel comfortable.

In Columbus, Ohio, that means places of worship.

“We have a large Bhutanese community here in Columbus, and we recently held an event at the temple that had a great turnout,” said Marian Stuckey, director of social work and neighborhood health for the city's department of public health. “Places of worship have been successful because it’s already a place where people are trying to be the best they can be, so they are more open to hearing about something like health insurance there.”

In cities with younger populations, such as Tampa, Fla., government leaders are going on the offensive. Getting more of the so-called young invincibles in the marketplace is expected to help drive and keep health premiums down. This is because "insurers need to spread risk across a broad pool of enrollees, including younger, healthier people, to offset the costs of older, sicker people," according to the RAND Corporation.

“Our need to get out in the community is so great this year," said Tampa Mayor Bob Buckhorn. "We have a governor who still won’t expand Medicaid, and Tampa’s a very young city (the average age is around 35). My wife is an ob-gyn, so I’ve seen the effects firsthand when people go without health insurance. Often when a women goes to the ER to deliver her baby, that’s the first time she’s receiving any prenatal care. All of us pay for that care when that happens."

To reach parents, Tampa officials are going where their kids go: recreation centers. The city's rec centers have temporarily expanded their hours and have navigators -- people certified to help others enroll in the Obamacare marketplaces -- on hand to answer questions and get people covered.

 

Both New Orleans and Tampa are also taking part in the White House-led “Healthy Communities Challenge” with 18 other cities deemed “high opportunity for impact.” The city with the most new enrollees gets a prize: a visit from President Obama.

But it’s not just Tampa that’s been proactive in getting out in the community. Florida, which accounts for nearly a fifth of the nation's early open enrollment signups so far this year, has people traveling to holiday events, street festivals, sportings events and college campuses to spread the word. They've also started doing promotions on urban and Hispanic radio stations to reach younger minorities.

“This year it’s about meeting people where they are, wherever that may be," said Jodi Ray, project director of Covering Florida, a nonprofit dedicated to helping people sign up for health insurance. This year they’ve also started working with prisoner re-entry programs so when they transition back into regular life, “they not only have a job, but have health insurance too,” she said.

Federal officials announced on Wednesday that just over 800,000 people signed up for insurance on the federal marketplace through the fifth week of the enrollment period. Most of them, however, are renewing their coverage: 63 percent to 37 percent of new enrollees. (Data is not yet available for the state-run marketplaces).

For city and state officials working to get people enrolled this year, though, they all said it’s not about reaching a certain number -- it’s about creating a healthier community.

“Younger people don’t always see the value in [insurance], so at these outreach events, sometimes all you need to say is that it’s there to protect you," said Jessica McCarron, regional communications director at Enroll America, a health-care enrollment coalition. “You’re just getting started in your life, you don’t want to get into an accident and become bankrupt because you’re not insured."

*This story has been updated to reflect the new deadline for getting health insurance that starts in January.

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