Hunt for uninsured labor-intensive task

HOLLYWOOD, Fla. - The hunt for the uninsured in Broward County got underway one recent afternoon when 41 canvassers, armed with electronic maps on Samsung tablets, set off through working-class neighborhoods to peddle the Affordable Care Act door to door. Four hours later, they had made contact with 2,623 residents and signed up 25 people.

Many of their targets, people identified on sophisticated computer lists generated in Washington as unlikely to have health insurance, had moved away. Some were not home. Many said they already had insurance through Medicare, their parents or a job. A few were hostile at the mere mention of President Barack Obama’s health-care law.

“We’re going to repeal that,” one man said gruffly as he shut the door in the face of a canvasser, Nancy Morwin, 58, a retired social worker.

Such are the limits of microtargeting the uninsured as groups supporting the Obama administration take to the streets on behalf of the president’s most important domestic initiative. The nationwide effort is modeled on Obama’s successful voter turnout machines in 2008 and 2012, but in this case the task of finding Americans without health insurance and signing them up is a painfully slow grind.

Although the administration expects many enrollees to make their own way to the government’s health-care website or the state exchanges, the door to-door effort is aimed at people without computers, email addresses or the wherewithal to show up at health fairs and other enrollment events at Kmarts or grocery stores.

Officials said the labor-intensive targeting program, while frustrating, could eventually add thousands of people to the rolls of the insured.

The campaign is staffed by organizations deploying thousands of paid and volunteer canvassers across the country. Planned Parenthood, one of the most aggressive groups, has raised millions of dollars for the effort. It is paying about 400 workers like Morwin $12 an hour. They are knocking on an average of 18,000 doors a day in eight states: Arizona, Colorado, Florida, Georgia, New Mexico, Ohio, Pennsylvania and Texas.

Enroll America, a nonprofit group that is trying to expand the health-care rolls, has hired 266 people and recruited 14,000 volunteers to not only canvass neighborhoods but also make calls at phone banks and host events at community colleges in 11 states. The group has also spent $7 million to advertise on the Internet.

The efforts are important for Obama, who has been damaged politically by the initial failures of his health care website. Now, with HealthCare.gov finally working, his administration and outside supporters are racing to meet their goal of signing up 7 million people by March 31.By the end of January, nearly 3.3 million people had enrolled. To the canvassers, at least, the original goal seems a long way off.

“Can’t sweat the small stuff, not in this biz,” Morwin said, after retreating from a rundown rental property on a modest street lined with palm trees in Hollywood, where she was once again informed that the person on her list no longer lived there. “You see the challenges I have?”

The canvassers’ lists are derived from data created at Enroll America’s offices in Washington by some of the same computer programmers who churned out the statistical models for Obama’s presidential campaigns. Using commercially available information, the data experts generate lists of people with rankings that indicate their likelihood of needing health insurance. The typical uninsured is younger, male and either low-income or unemployed.

People are scored from zero to 100, with those at the top most likely to be uninsured. By using an uninsured score of 20 or higher, Planned Parenthood is casting a wider net to improve the chance that its door-knockers find people without insurance. In Broward County, home to 1.39 million people, the Enroll America data lists 284,000 such targets between the ages of 18 and 45.

In Florida, Planned Parenthood has turned the data into“heat maps” of the uninsured, with neighborhoods colored in varying intensities of red to indicate where most of the targets live.

“I like to think about it as a compass,” said Matt Saniie, Enroll America’s data specialist and a former member of Obama’s re-election team. “It gives you a direction.”

But on the ground, Saniie’s lists are far from perfect and offer the canvassers little more than a rough road map. There are no signs in front yards that proclaim, “I don’t have health insurance.” Some people were embarrassed and unwilling to admit they were not covered.

Others approached by the canvassers were immediately suspicious.

“Why do you have my name?” asked one woman.

But the canvassers said some of the uninsured were eager to sign up.

After more than an hour canvassing Hollywood for Planned Parenthood, Alberonick Valsaint, 42, had yet to sign up anyone for health insurance. Then he approached a small three-room house where Yersson Llabreras, 35, was putting on his McDonald’s uniform and getting ready for work.

Llabreras said that his 9-year-old son was asthmatic and that he had tried in vain late last year to sign up for coverage on the government’s health-care website. “For real, we need it,” he said.

So for more than half an hour, Valsaint walked Llabreras through the process of creating an account on healthcare.gov so he could select an insurance plan. When Llabreras had to leave for his job, Valsaint continued with Llabreras’ wife, Diana Camacho. The family of four is now on its way to getting health insurance.

The day before, Morwin, the canvasser for Planned Parenthood, met Francisco Padilla, 42, in a mobile home park. Padilla’s job as a forklift mechanic pays $375 a week but does not offer health insurance. Married with three children, Padilla had tried to sign up on healthcare.gov, with no success.

“They told me I qualify for Medicaid, but I’ve been trying, trying, trying. Nothing,” he told Morwin, who took his name and telephone number and promised that someone from Planned Parenthood would follow up.

By the end of her shift, Morwin had knocked on 115 doors and talked to 16 people about enrolling. Not one of them signed up.

In some cases, problems with the health-care website are still frustrating the canvassers’ best efforts.

Ryanbo Morales, 27, a Planned Parenthood worker and a former campaign volunteer for Obama, searched for the uninsured one recent day with the same zeal he brought to looking for voters during the president’s 2012 re-election campaign. But when he finally found Chrystal Rhodes, 24, who said she did not work enough hours at JetBlue to qualify for its health insurance, his efforts to help her sign up on his Samsung tablet were stymied when she kept getting an enrollment error.

“This is really unfortunate,” Morales said.

Canvassers attend brief orientation sessions before they head out. In Florida, a team of Enroll America workers recently held one in Judy Cloutier’s home in Boynton Beach. “Speak in plain terms, don’t get too complicated,” Florence French, 49, an organizer, told the group.

Near the end of the day, Jack Laplanche, 63, one of the canvassers, found Lafortune Louis, 56, a Haitian immigrant who hurt his back in 2007 and lost his job laying underground pipes. He and his family have not had insurance since.

“If you get someone coming to your door, it really helps you,” Louis told Laplanche as he signed up for an enrollment event in Delray Beach.

Nicholas Duran, Enroll America’s Florida director, said his group plans to be even more aggressive before the March 31 deadline to sign up for coverage.

“The intensity is definitely ramping up,” he said, comparing the efforts to reach the uninsured to candidates’ efforts to reach voters. “They are going to hear from us multiple times between now and the end of March until they tell us they have insurance. It’s just like a campaign.”