LOS ANGELES — Nahla Kayali is a foot soldier for Obamacare.
She is among the first wave of 2,000 community organizers in California getting trained to persuade more than 1 million uninsured people in the state to sign up for subsidized health coverage under President Barack Obama’s reform law.
Kayali and her cohorts begin their mission next month, armed with flyers, pamphlets and a small army of volunteers who speak 13 languages.
“We’re getting consumers and small businesses the tools to enroll, and trying to eliminate the barriers to enrolling,” said Kayali, 55, who runs a non-profit that provides social services to Arab Christians and Muslims in Orange County, just south of Los Angeles. “We’re going to break down the stigma — any barrier, whether it’s a language barrier or a cultural barrier.”
Among U.S. states, California will have the largest force deployed in a massive national outreach effort costing hundreds of millions of dollars. These thousands of foot soldiers will have to promote the Patient Protection and Affordable Care Act in the face of widespread political opposition and public skepticism.
Their work is key to the success of the new law in its first year, when the Obama administration seeks to enroll as many as 7 million people, including 2.7 million young and healthy people who are cheaper to insure, for 2014.
Oregon and Vermont have already begun training their enrollment advisers, while Connecticut and Washington are just starting up and other states, including Illinois and New York, will commence later this summer.
The playbook for these ambassadors focuses on two main points: First, tell people how they will benefit from Obamacare; second, stay away from divisive political talk.
“There is a major effort … to try to educate Americans,” said Michael Sparer, head of American health policy and management at Columbia University’s Mailman School of Public Health. “There are extraordinary levels of confusion over what the Affordable Care Act, or Obamacare, does and does not do.”
Opponents of the health reform law have criticized the public funds spent on mobilizing tens of thousands of people like Kayali into what they say is a highly politicized campaign. Michael Cannon, director of health policy studies at the libertarian Cato Institute, says it may not work despite the expense.
“They’re trying to sell millions of people something that they’ve already shown they don’t want and they’re trying to do it in a very confused and politically polarized atmosphere,” he said. “They don’t realize what they’ve got themselves into.”
A concern for every community
The outreach advisers will counsel Americans on what kind of coverage they need, what kind of subsidies they may qualify for and how to sign up. Some are paid through federal grants or by private organizations, while others are volunteers. Hospital staff, already schooled in helping uninsured patients determine whether they are eligible for government programs like Medicaid, are expected to lend a hand.
California is spending $140 million on enrolling consumers and small business owners for the state’s new healthcare exchange, including $86 million worth of advertising time, said Dana Howard, a spokesman for the Covered California exchange.
The ad campaign will roll out during the fall, Howard said, so the information is fresh in consumers’ minds as enrollment begins in October. Along with television, newspaper and website ads, it will include social media campaigns on Facebook, Google+ and Twitter, he said.
When they hit the streets, however, they may meet considerable obstacles, from the political to the personal.
Kayali expects to find resistance from Arab immigrants who fear government assistance could make them vulnerable to corrupt politicians — as they might have been in their home countries.
“They’re afraid it might affect their legality, and they are afraid the government will want something from them in return,” she said.
It was to learn how to deal with such skepticism — among other obstacles — that Kayali and several hundred other non-profit administrators sat in a medical center training office in a Los Angeles suburb last week.
“Never make any political representation in any presentation,” trainer Laquetta Shamblee told the group. “We don’t make political statements even if we have a political opinion.”
Just the facts
Shamblee also admonished trainees to keep their groups’ political materials — on immigration, Middle East policy or other issues — away from events where they promote the Affordable Care Act, along with any statements about the law or Obama.
“Everybody has a cell phone, and we don’t want to be on ‘60 Minutes,’” she said.
Shamblee, who has a background in healthcare advocacy, said the state is not offering trainees lessons in how to counter potential opponents who might approach them at schools, churches or other places they set up tables. They are being advised not to engage in potentially inflammatory talk at all, but simply provide factual information about how to get health insurance through the exchange.
“Once people get the details, if it’s something that benefits their families they will look into it,” she said.
In Los Angeles County, Tina Wong will field a team of Spanish-speaking ambassadors going door-to-door to offer information to Latino consumers.
Like Kayali, she expects to find resistance: In Los Angeles County, 11 percent of the adult population is undocumented — ineligible to purchase insurance from the exchange and at risk of deportation if their status becomes known. That may prevent many families from signing up — even if some loved ones, including U.S.-born children, are eligible.
“Our biggest obstacle will be fear among parents who are undocumented to enroll their children,” said Wong.
She is acutely aware of how divided American families may be about the law, as her husband, a Republican, staunchly opposes Obamacare and believes that the uninsured should not rely on the government for health coverage.