California is racing to enroll its still-uninsured residents, and one Sacramento neighborhood is among dozens lagging behind, found an innovative study looking at the country’s millions of uninsured.
The third open enrollment period under the Affordable Care Act began this month, and California has a lot to show from the first two rounds. The proportion of uninsured residents statewide has dropped to only 11 percent, thanks to Medi-Cal expansion and aggressive efforts from Covered California, the state’s official health insurance marketplace under the federal program. Roughly 3 million Californians remain uninsured – down from 6.5 million in 2013.
Still, pockets of uninsured residents throughout the state continue to worry health access groups. If not enrolled this season, those people may be left behind as attention shifts away from enrollment and toward access and retention, suggests the report by the nonprofit group Enroll America. Those who remain uninsured also could face tax penalties for not enrolling.
The Parkway neighborhood in south Sacramento is home to about 5,000 uninsured residents, placing it among the state’s top 50 zip codes by number of uninsured adults, along with about 20 Los Angeles neighborhoods and several zip codes in the Central Valley and Bay Area, Enroll America found.
Of the 3 million people still uninsured statewide, about 2 million are eligible for coverage, while the rest are disqualified by their immigration status. Experts say eligible but still uninsured residents come from two main groups – families of undocumented people who distrust government-funded programs, and those who have gone without insurance for years and feel they no longer need it.
“These folks are getting hard to find,” said Nicole Oehmke, California project director for Enroll America. “There have been years of finding hundreds of people, and now we’re having a hard time finding the remaining uninsured. ... The tremendous outreach efforts from both Medi-Cal and Covered California just aren’t reaching them.”
Enroll America is a national nonprofit group that analyzes data to help local groups reach uninsured Americans. The group surveyed 12,000 uninsured people nationwide to create data models for states, which included identifying the top 50 most uninsured California neighborhoods in each of three categories: largest uninsured population, highest rate of uninsured adults and uninsured population density.
The Parkway neighborhood, stretching from 47th Avenue to Sheldon Road and between Franklin and Stockton boulevards, was the only one in Sacramento County identified in the report.
The hope is that the data will help outreach groups such as Sacramento Covered, a nonprofit dedicated to insuring more Sacramentans, better tailor their enrollment efforts to previously unreached populations. That might mean partnering with community organizations representing specific minority groups, or staging large sign-up events in strategic neighborhoods, Oehmke said.
Ethnically, Parkway is a hodge-podge of Hispanic, African American and Asian residents, who together make up 85 percent of the population. Cultural barriers may explain why enrollment efforts have not been as effective there as in other places, outreach workers said.
Kelly Bennett-Wofford, executive director of Sacramento Covered, said the 95823 zip code has always been on her staff’s radar, and is one of the areas where they work most frequently. Still, many people there are intimidated by the process of enrolling in insurance or feel they can’t afford it, she said.
To combat that perception, the organization has hired people from the neighborhood and sent culturally competent “navigators” to inform people of the accessibility of health care and assist them with paperwork.
“People still want someone to explain the program to them, and they want that in-person assistance from someone who is trusted,” Bennett-Wofford said. “Someone who looks like them, speaks their language, can connect them to an interpreter, and in many ways can explain how coverage itself works.”
Covered California also has generated “heat maps” that pinpoint where the state’s biggest enclaves of uninsured reside, primarily in Los Angeles and the Bay Area, said Covered California spokeswoman Amy Palmer. The mapping is based on census and enrollment data, as well as academic research and health care surveys.
Palmer said data mapping enables Covered California to deploy, for instance, Korean-speaking insurance agents to neighborhoods where data show large numbers of uninsured speak that language. “We are making steady progress toward identifying the subsidy-eligible at the neighborhood level to make sure they have an opportunity to enroll,” Palmer said.
But even with all the resources, she said, “to a certain degree, the work we do to identify the currently uninsured involves some guesswork. It’s informed guesswork, but it is guesswork.”
Sacramento Covered has learned that health fairs and other mass enrollment events, though they may raise awareness and spread information, are not always the best way to put people at ease with the process. Health navigators have had greater success in more intimate settings such as Prairie Elementary School, where, starting this week, they’ll be stationed Tuesday through Thursday from 8:30 a.m. to 4:30 p.m.
Adela Recio, a bilingual health navigator who worked at the school for Sacramento Covered for nine years, said most people she met there were afraid to enroll because of their own immigration status or the status of someone in their family.
“I have to be able to connect to the family,” she said. “I have to get them to let me help them. They have to tell me basically their whole story.”
Claudia Buck contributed to this report.