WASHINGTON -- As Obamacare emerges from the rubble of its first two months, local organizers, state officials and the White House see a clear path forward. With the website now quasi-functional, there are good reasons to believe that the Affordable Care Act will catch on. Quite simply, there are tens of millions of uninsured people who want health insurance, a law in place to help them obtain it, and advocates on the ground making sure they know how to do it.
For on-the-ground organizations, Obamacare represents a once-in-a-generation organizing opportunity. By signing someone up for health insurance, they are delivering a tangible benefit, something that person will value for years to come, and winning loyalty along the way. Nonprofits, as well as mayors and governors, have an intense incentive to make Obamacare work.
And millions of those uninsured people -- many of them young and healthy -- are in tightly concentrated urban areas, target-rich environments for the grassroots groups and politicians working to sign people up.
Take Los Angeles County. More than 2.2 million uninsured people live there -- nearly 5 percent of the entire country's uninsured population. In the Houston metro area, there's Harris County with more than 1.1 million uninsured. Add in Cook County, which includes Chicago, and Miami-Dade County in Florida, and the numbers of concentrated and targetable uninsured quickly add up.
The importance of these counties to Obamacare's success is not lost on anyone. "California is ground zero for this," said Steven Abramson, a marketing manager for the Community Health Alliance of Pasadena. "And LA County is ground zero for California."
Abramson said his group and other local clinics will be augmenting their enrollment events and outreach efforts with a new initiative called Cover LA, which launches in December and will include videos being played on transit buses to promote a website and call center. The website will let residents search for enrollment events by zip code.
Manpower is being ramped up across the county. Covered California, the state's health insurance exchange, has 448 navigators operating in Los Angeles County with an additional 1,300 in the process of being certified, said the exchange's Larry Hicks.
In Texas, the focus is on those counties with the most uninsured. Tiffany Hogue, the health care campaign director with the Texas Organizing Project, said that of her group's 12 community organizers, seven are working in Harris County. Another three are in Dallas County along with the project's statewide organizing director. Given the number of uninsured in those two areas, Hogue said their importance is obvious.
SEIU-United Healthcare Workers West, which counts some 150,000 hospital and nursing home workers and home care aides as members, has also targeted LA County. With the help of a grant from the California Endowment, the union had started enrolling the uninsured who will qualify for the state's version of Medicaid (known as Medi-Cal) before the Oct. 1 Obamacare rollout.
Sean Wherley, spokesman with SEIU-United Healthcare Workers West, said the union has signed up 3,000 for Medi-Cal so far. Most of them are in LA County, he said, and many come from a single neighborhood, Boyle Heights. "It's kind of the target demographic -- Latino, uninsured, but eligible to be insured," said Wherley.
Because of the geography of poverty, one gathering can make a real dent in the uninsured population. One event in Sacramento was attended by 1,500 people. "Almost 500 started the enrollment process in Obamacare," said Wherley. "They had 300 volunteers at the event."
The concentration of America's uninsured is central to the administration's optimism. For months, senior White House officials have been reminding reporters in briefings about the millions stacked up in Los Angeles, Chicago and other easily accessible urban areas.
The White House is using its power to generate media interest to shine a light on those areas. In recent weeks, top administration officials have visited Los Angeles, Chicago, Dallas, Houston, Miami, Atlanta, Phoenix, northern New Jersey, Tampa, Orlando, Detroit and San Antonio, home collectively to more than 7 million uninsured. The visits generate press coverage and elevate the on-the-ground organizing efforts.
Health and Human Services Secretary Kathleen Sebelius hit Phoenix on Oct. 24 and San Antonio the next day. Three days later, top White House health care official Cecilia Munoz visited Detroit for an event that connected navigators with residents. The next day, Agriculture Secretary Tom Vilsack stopped in Atlanta to tout Obamacare.
The following week, Obama himself visited Dallas, and Housing and Urban Development Secretary Shaun Donovan went to Tampa.
These Obamacare visits to uninsured hot spots are reinforced on the ground, like campaign stops, with a coordinated effort among unions and nonprofits doing local outreach. "We approached it much like you would a political campaign with mailings, door knockings, repeated attempts. And phone banking," Wherley said. "You need to hit people multiple times from multiple formats. One to get them, two to help them understand how this works and get them to an event where they can actually enroll." The union created a nonprofit to do the Obamacare outreach.
Mariaelena Querales is one of those LA County organizers on the other end of the phone or knocking on the door or greeting people at Obamacare events. She told HuffPost that supervisors have broken down the outreach into four zip codes and that she has been assigned specific areas to cover within one zip code. She estimates that she has talked to 2,000 residents on her own.
Mostly the outreach involves education. "A lot of people don't understand what ACA or Obamacare is," Querales said.
People are naturally skeptical when someone knocks on their door offering a service, said Noemi Caraveo, 22, a Community HealthCorps member through AmeriCorps. "It's just a matter of getting their trust," said Caraveo, who's working in LA County. "I tell them I'm just trying to help, I'm not getting any commission. Once that happens, they are more like, 'OK.'"
Mimi Garcia, the Texas state director with Enroll America, sees her operation in much the same way as her counterparts in Los Angeles. The Texas outreach campaign launched in June with the view that both Harris and Dallas counties were key, Garcia said, adding that the campaign has made the Obamacare pitch to thousands in those counties.
"We've done a lot of door knocking and canvassing," Garcia said. "In Dallas, we have worked a lot with the black Baptist churches and the Hispanic evangelical churches to have info sessions on Sundays and Wednesdays, working through the congregations themselves to build up volunteer teams."
In Houston, the health department gave Enroll America a temporary office in its building. Kathy Barton, chief of public affairs with the Houston Health Department, said that the group is helping to map where the uninsured are. But she added this caveat: "We haven't had a lot of enrollment because of the problem with the website."
Unlike California, Texas did not create its own health insurance exchange. Nor did Gov. Rick Perry (R) provide a dime in state funding for Obamacare outreach. Instead, public health officials in Houston and nonprofits have sponsored some 170 events, Barton said.
But all the organizing and community outreach in Texas, and many other Republican-controlled states, will necessarily fall short of Obamacare's ultimate goal. Since Perry has refused to expand Medicaid, many in the state will still be unable to afford health insurance.
"It's going to be really sad that there will be a significant number of people we will not be able to help," Barton said.
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President Franklin D. Roosevelt favors creating national health insurance amid the Great Depression but decides to push for Social Security first. (Photo by Keystone/Getty Images)
Roosevelt establishes wage and price controls during World War II. Businesses can't attract workers with higher pay so they compete through added benefits, including health insurance, which grows into a workplace perk. (Photo by Hulton Archive/Getty Images)
President Harry Truman calls on Congress to create a national insurance program for those who pay voluntary fees. The American Medical Association denounces the idea as "socialized medicine" and it goes nowhere. (Photo by Keystone/Getty Images)
John F. Kennedy makes health care a major campaign issue but as president can't get a plan for the elderly through Congress. (Photo by Keystone/Getty Images)
President Lyndon B. Johnson's legendary arm-twisting and a Congress dominated by his fellow Democrats lead to creation of two landmark government health programs: Medicare for the elderly and Medicaid for the poor. (AFP/AFP/Getty Images)
President Richard Nixon wants to require employers to cover their workers and create federal subsidies to help everyone else buy private insurance. The Watergate scandal intervenes. (Photo by Keystone/Getty Images)
President Jimmy Carter pushes a mandatory national health plan, but economic recession helps push it aside. (Photo by Central Press/Getty Images)
President Ronald Reagan signs COBRA, a requirement that employers let former workers stay on the company health plan for 18 months after leaving a job, with workers bearing the cost. (MIKE SARGENT/AFP/Getty Images)
Congress expands Medicare by adding a prescription drug benefit and catastrophic care coverage. It doesn't last long. Barraged by protests from older Americans upset about paying a tax to finance the additional coverage, Congress repeals the law the next year. (TIM SLOAN/AFP/Getty Images)
President Bill Clinton puts first lady Hillary Rodham Clinton in charge of developing what becomes a 1,300-page plan for universal coverage. It requires businesses to cover their workers and mandates that everyone have health insurance. The plan meets Republican opposition, divides Democrats and comes under a firestorm of lobbying from businesses and the health care industry. It dies in the Senate. (PAUL J. RICHARDS/AFP/Getty Images)
Clinton signs bipartisan legislation creating a state-federal program to provide coverage for millions of children in families of modest means whose incomes are too high to qualify for Medicaid. (JAMAL A. WILSON/AFP/Getty Images)
President George W. Bush persuades Congress to add prescription drug coverage to Medicare in a major expansion of the program for older people. (STEPHEN JAFFE/AFP/Getty Images)
Hillary Rodham Clinton promotes a sweeping health care plan in her bid for the Democratic presidential nomination. She loses to Obama, who has a less comprehensive plan. (PAUL RICHARDS/AFP/Getty Images)
President Barack Obama and the Democratic-controlled Congress spend an intense year ironing out legislation to require most companies to cover their workers; mandate that everyone have coverage or pay a fine; require insurance companies to accept all comers, regardless of any pre-existing conditions; and assist people who can't afford insurance. (Alex Wong/Getty Images)
With no Republican support, Congress passes the measure, designed to extend health care coverage to more than 30 million uninsured people. Republican opponents scorned the law as "Obamacare." (Mark Wilson/Getty Images)
On a campaign tour in the Midwest, Obama himself embraces the term "Obamacare" and says the law shows "I do care." (BRENDAN SMIALOWSKI/AFP/Getty Images)