Eager to maintain the state's reputation as a leader in implementing the Affordable Care Act, California officials are putting the finishing touches on a plan to send thousands of newly hired emissaries to spread the word about health care reform.
Officials hope their massive public education and outreach campaign starting next month will reach deep into hidden pockets of the state and attract a large pool of newly insured individuals into Covered California, the state's health insurance exchange. Exchange officials hope to enroll 1.4 million next year from a pool of about 5.3 million who will be eligible.
A new army of outreach workers -- part of an estimated 21,000 new employees working directly and indirectly for Covered California -- will be knocking on doors, holding informational gatherings likened to Tupperware parties and visiting hundreds of schools throughout the state.
Covered California officials said it is critical to reach the uninsured and inform them about new health law provisions taking effect in six months. The goal of the outreach campaign is to increase awareness about new benefits available to consumers, educate "targeted" audiences about subsidies available under Covered California and to motivate people to enroll.
The state's biggest target? Latinos.
In awarding 48 community groups, schools and health clinics $37 million in federal outreach and education grants last month, Covered California officials underscored the importance of reaching the largest uninsured populations.
Latinos make up 42% of the population in California but account for a disproportionate share of its uninsured residents. According to a 2012 report by the California HealthCare Foundation, Latinos constitute nearly 60% of the state's uninsured population. CHCF publishes California Healthline.
"Latino outreach is going to be very important," said Shannon McConville, a researcher at the Public Policy Institute of California specializing in issues surrounding health policy and racial and ethnic health disparities. "When you look at who is currently uninsured and who will become eligible for coverage, it's impossible to ignore the Latino population. Based on current numbers, they are the largest uninsured group in California."
McConville pointed to a January 2013 PPIC opinion poll that gauged public opinion about the new health law. According to the statewide survey, 32% of Latinos said they would be better off under the new health care law, compared with 21% among whites. Conversely, the poll showed that 37% of whites said they would be worse off, compared with 11% of Latinos.
L.A. Group's Far-Reaching Plans for 'Promotores'
Vision y Compromiso, a Los Angeles-based advocacy group that focuses on issues effecting the Latino community, won a $1 million grant from Covered California for education and outreach in late May.
Melinda Cordero-Bárzaga, Vision y Compromiso's associate director, called the health reform law "life-saving" for the community she serves.
"There are going to be so many changes that occur under Obamacare," Cordero-Bárzaga said. "So we have to ensure that the community understands the changes, and how they'll affect them.
"They'll need to be able to find resources to enroll in health insurance, they'll need to understand if they're eligible to enroll, and whether or not they're eligible for government subsidies," Cordero-Bárzaga said.
During the 18-month education campaign, Vision y Compromiso will hire 23 outreach workers to fan out over seven regions of the state, including major metropolitan centers in Los Angeles, the Central Valley and the San Francisco Bay Area, Cordero-Bárzaga said. Community health workers known as "promotores" (promoters) will work with schools, local community leaders and other not-for-profits, such as health clinics, to reach uninsured Latinos who could be eligible to purchase insurance beginning Oct. 1.
"One of the biggest barriers we're going to face is working with a community who might not know how to navigate a very complicated health care system," Cordero-Bárzaga said. "We've already talked to a lot of people who have been here for years but don't know where to go for health care. We have to change that."
In addition to communicating new policies such as subsidies and terms like copayment and deductible, Cordero-Bárzaga said health care workers will face significant cultural challenges.
"There is a lot of fear in the immigrant community when it comes to receiving any kind of government assistance," Cordero-Bárzaga said. She said many are involved in immigration issues "and don't want anything to work against them. You also have to remember the government in Latin America and Mexico is not always very accessible or trustworthy."
Christina Pacheco knows what it's like to penetrate many of those barriers. A community health aide who works primarily in Los Angeles, Pacheco has been a promotora for nearly 15 years. She said it's important to go where the community is -- schools, food banks, parks and areas frequented by day laborers.
Pacheco said she expects her work to double next month when she'll begin outreach with Vision y Compromiso.
"It's important to engage parents and gain trust in the community so they'll understand that this is a good thing," Pacheco said. "It's going to be very new, so I'll start out simply, by simply asking them how they are doing and how they are getting health care right now."
"A lot of people are interested, and a lot of people are already asking questions," Pacheco said.
Lina Mendez -- a scholar at the UC-Davis Center for Health Disparities, which also received a $1 million education and outreach grant -- echoed Pacheco. She said gaining community trust is the most important step in encouraging Latinos to sign up for health care.
"Especially in families where some are documented and some are undocumented we are going to have to be able to gain the trust of each family member," Mendez said. "We have to teach them that the information we're giving them is beneficial and it's not going to harm their immigration status."
Outreach Internships, 'Tupperware' Parties
Mendez said the Center for Health Disparities plans to hire two additional outreach workers and create an internship program at UC-Davis in which undergraduate and graduate students work as health assisters in return for course credit and experience. Most of the outreach will be conducted on nights and weekends, Mendez said.
"We want to make sure we reach the most people that we can," Mendez said. "We also plan on doing a lot of grassroots outreach, holding what is comparable to Tupperware parties. For example, we'll invite around 20 people and ask one of them to host it, then at the end, we'll ask another person to host a party and invite 20 people they know."
"We know it's a lot of hard work, but we also know it's the best way to reach people who aren't going to come to us for information," she added.
Obstacles that outreach workers say they'll encounter span the spectrum of the uninsured. Many issues, such as immigration status, language, income level and cultural barriers in the Latino community also hit home for thousands of other Californians.
Larry Hicks, a spokesperson for Covered California, said creating policies that result in people signing up for insurance in the exchange is critical to keep the cost of health insurance down, while allowing thousands to access care -- some for the first time in their lives.
Grantees, known as Covered California certified educators, "are very important to the success of expanding quality health care and affordable health care to Californians," Hicks said.
"These are people who are already active in their communities, so they're trusted," Hicks said. "After receiving training from us, they can reach out to community members where they live, work, play, pray and shop, to provide them with the information they'll need to enroll in Covered California health plans."