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Obamacare Enrollment: Lessons From Year One Obamacare Enrollment: Lessons From Year One

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Obamacare Enrollment: Lessons From Year One

Navigators and volunteers set up shop in thousands of communities nationwide to get people signed up for health coverage.


(Joe Raedle/Getty Images)

If Obamacare enrollment was President Obama's "last campaign," Election Day is Monday.

In a bid to get enough Americans—particularly young, healthy Americans—to enroll in the Affordable Care Act's exchanges, Obama mobilized much of the same army of organizers and volunteers that won him two terms in the White House. Now, with their work largely over, the team is looking back, sorting their triumphs from their failures.


But even as the number of sign-ups crossed 6 million last week and open enrollment is all but closed, the law's unofficial volunteer corps is already strategizing for what's to come: yet another long, hard push to get citizens to sign up before the next enrollment period.

"We are by no means shutting our doors," said Anne Filipic, a veteran of the Obama White House and the 2012 campaign who now runs Enroll America, the leading organization tasked with maximizing the number of people signing up for insurance through the Affordable Care Act.

Enroll America targeted a handful of states with large uninsured populations and political leaders who weren't going to help implement Obamacare. Ray Paultre, Florida organizing director for Enroll America, described the operation like a campaign, complete with field staff and regional directors.


"If we could do it all over again, how would we do it different?" Paultre asked. "I would say we were 80 to 90 percent door-to-door contact. But it wasn't so much that door-knocking didn't work, it was that commit cards worked so well."

Volunteers got consumers to fill out "commit cards," pieces of paper where a person could indicate whether they were uninsured, had insurance they didn't like, or knew someone who fell into one of those two categories. Then they'd follow up to set up an in-person appointment with a navigator—a certified insurance helper who could tell consumers more about their new insurance options and guide them through the enrollment process.

"These are people who have never had insurance. They don't understand premiums, co-pay, deductibles," said Karen Basha Egozi, CEO of the Epilepsy Foundation of Florida, which received a navigator grant to help residents sign up for health insurance. "They come in and some of them don't even have an email, so they can't sign up on"

In the beginning, people struggled to get their applications through the faulty federal exchange site, and some are still working on it, Basha Egozi said.


"A lot of people come back," Basha Egozi said. "We see people two, three times, especially those that started in October."

Basic education about health insurance remains the biggest responsibility for Obamacare's messengers.

"We have to continue doing education," said Rachel Alein, enrollment program director at Families USA. "I think back to October ... a lot of the public, and specifically the uninsured, had not heard about a lot of the changes that were coming. They maybe had heard of Obamacare, but they didn't know how it would affect them."

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And explaining the complex system was hard to do before was fixed and people could compare their real-life options.

"We struggled with that a lot in advance of the open-enrollment period," Alein said. "Everyone really wanted to get out and start talking to people about it. There were some reasons why it didn't happen en masse sooner because we didn't know what the online application looked like and I think it's hard to do the enrollment without having the information in front of people. How soon can you start talking about it when it isn't real yet?"

It's one of the reasons she is hopeful about the next enrollment period. Once more information is available about who signed up, Alein said, organizers can refine whom they reach out to and the message they bring, based on what worked the first time.

"This was a tremendous first step," Alein said. "What we know for next year is that now that everything is working for and most states' websites, advertising can happen earlier and it can contribute to a truly sustained public and private partnership to get the word out to people about their new coverage options and the availability of financial help."

Developing trust was a critical component of enrollment efforts, Filipic said. Enroll America's volunteers would work with existing community networks to reach potential enrollees in a setting where they already felt comfortable.

"In the past, people couldn't find health insurance that met their needs or was affordable to them," she said. "We found that people come to this process with a lot of skepticism, and that it takes information about financial assistance to show that this time it's different."

Leveraging existing community organizations also helped set the uninsured at ease, especially among the Latino population which has a high uninsured rate, said Juanita Mainster, a navigator at the Epilepsy Foundation.

"We get mixed families that do have members of the family who are undocumented," Mainster said. "If you know the community, and the community knows the organization providing the service, they tend to feel more confident and relaxed when you tell them they're not going to get in trouble with anybody."

Though the work is mostly over—save for those who are getting more time to enroll or who qualify for Medicaid—Nov. 15, the volunteers said, doesn't feel so far away.

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