California has more uninsured people than other states have people.
With that in mind, think about this: By Oct. 1, the state has to have its health insurance exchange up and running, ready to offer an estimated five million people some kind of insurance. However, polls indicate a good portion of the uninsured don't know about the push to recruit them.
The state has a lot of ground to cover before the looming deadline, and is banking on an all-out marketing blitz.
Here's a typical story. At the LifeLong Clinic in West Berkeley, Leila Herbert Gray walks in with her mom.
“My ear hurts," the 6-year-old says.
It started hurting five days ago, and it's getting worse. Her mom Tenisha Herbert adds, "I’ve been trying to give her Tylenol to you know, numb the pain some. But it’s not working."
Herbert does not have insurance. She canceled the coverage available through her employer because the monthly premiums were too high.
When health reform kicks in, Herbert may be eligible for tax breaks that make it easier to afford insurance and she may also get better deals. She didn't know about any of this until just now.
Mega-bucks into advertising
Herbert's access to affordable care, similarly to millions of Californians, turns on whether the state's health insurance exchange manages to reach her.
Peter Lee is the director of Covered California, and he's got roughly 251 days to cover the entire state before Obamacare kicks in. Lee has a budget of about $290 million to reach 5.3 million Californians.
"It’s a big spend, but we are a very big state," he says.
Slightly less than half of the money is going into TV ads and other traditional media buys -- which, by the way, is more than President Barack Obama and Mitt Romney combined spent on advertising in their toughest battleground state Ohio.
Covered California is putting the majority of its money into social media, data mining and boots-on-the-ground outreach. Thousands of health care workers will be scouring California, even going door-to-door in search of the uncovered.
Lee says, "It's the biggest change since Medicare," and a huge challenge.
According to a recent poll, ninety percent of Americans don't know insurance exchanges like his are opening this fall. About one million of those eligible in California don’t speak English well. So Lee has to open call centers that can handle a dozen languages, from Armenian to Tagalog.
Another problem, ironically, is that most of the uninsured are healthy. They don't need a doctor this minute. Obamacare needs them to subsidize the cost of covering the sick.
Lee explains insurance is a business.
“When we open our doors, that woman with breast cancer who’s been denied coverage, she’s going to find us," Lee says. "She’s going to get in the door.”
But that healthy woman who doesn’t make a lot of money, she won’t jump at the chance to pay for coverage.
Private sector wants more care
Covered California is getting help from the state's largest health foundation. The California Endowment is putting $225 million into the pot.
Vice President Daniel Zingale says with so much to do, the government can't do it alone.
"There's still a lot of confusion," he says. "Even people who say they think it's probably a good thing are surprised when they find out they may be eligible."
But three to four million immigrants in California, most with legal status, some without, are not eligible. The Endowment is running a parallel marketing campaign, urging the state to change that by keeping county-run programs open and expanding Medicaid on the government's dime. In one video airing throughout the state, Latinos look into the camera and ask if California stands for universal coverage. “Does that mean everyone, everyone? Does everyone include me? Us too?”
Zingale says it makes sense to have as many options as possible for uninsured families, like Tenisha Herbert and her daughter Leila.
Back at the Lifelong Clinic, the Herberts apply for Medicaid. Caseworker Cynthia Gonzalez pulls out a form with a scary title: Self-Pay Declaration.
"If it's not approved, then that means you will be stuck with the bill."
Herbert nods, "I'm liable for the charges, yes," and signs.
Today she can't afford to worry about the cost of a visit. Her daughter needs a doctor.