Michigan spends little to promote health care law

LANSING, Mich. (AP) -- Just five states will spend less per capita than Michigan to get the word to uninsured residents about how to enroll for medical coverage under the federal health care law starting this fall.

Michigan's $5.7 million in outreach spending amounts to 58 cents per resident, according to data compiled by The Associated Press, far less than states that have embraced the Affordable Care Act.

The reason the state is spending so little is the GOP-led Legislature rejected partnering with the federal government on a health marketplace where people can shop for insurance starting Oct. 1. Michigan lost out on $31 million, all but $12 million of which would have gone toward consumer assistance under Republican Gov. Rick Snyder's plan.

"It's a significant setback. We wish there were more resources on the ground to educate the public. But we think word of mouth certainly is going to be helpful," said Don Hazaert, director of Michigan Consumers for Healthcare, a coalition of groups backing the law and working to help implement it.

The U.S. government is sending about $3.8 million to roughly 30 low-income community health clinics in Michigan to hire about 70 workers to help sign people up for insurance. Another $1.9 million will be awarded next month to "navigators" — groups or individuals also tasked with raising awareness, educating the public and enrolling the uninsured in health plans.

Their job won't be easy. They must find a hard-to-reach group of 1.2 million mostly working poor and young people without health insurance, many with a high school education or less. Nearly eight in 10 of Americans eligible for the insurance exchange don't know about it, according to Enroll America, a nonprofit trying to spread the word about the health overhaul.

"They don't understand how health care reform will impact and help them," Hazaert said. "We really need to be putting resources into educating the public and what their enrollment options are. Unfortunately much of that money has been sent back to the federal government."

Advocates have asked federal officials to send Michigan's turned-away allotment to nonprofits or other organizations in the state so the marketing effort doesn't suffer. It's not immediately clear what the Obama administration will decide or to what extent it will do its own public relations blitz in a state where it's solely responsible for the new exchange where people or businesses can buy a government-subsidized private plan.

One health center ramping up outreach efforts is InterCare Community Health Network, which treats low-income patients in six counties in southwest Michigan. More than one-third of the 50,000 people seen at a handful of its clinics are uninsured.

InterCare is using a federal grant to hire five employees to split their time between a health clinic and being out in the community — at county health departments, Head Start classrooms, grocery stores and elsewhere. Each will be expected to sign up 1,000 individuals in a year, or an average of three to four per workday.

Enrollment for the exchange will last from October through March and start again in October 2014, though Medicaid signup go on all year. Tax credits will go to people with incomes up to 400 percent of the federal poverty level, or about $92,000 for a family of four.

The state Senate is considering whether to approve House-passed legislation that would expand Medicaid eligibility to more low-income adults starting in January.

"The outreach and education is really critical because it's a very complex law and folks are just going to need a lot of assistance navigating their way through the system," said Judy Rayman, InterCare's executive vice president.

Health centers are waiting for details of an online training program the newly hired counselors must complete before going into the field.

"If the training goes live soon, I think we'll be ready" by Oct. 1," Rayman said.

Enroll America, a coalition of health companies and advocates, has deployed full-time organizers and volunteers in Michigan because it's a big state with more than 1 million uninsured and to supplement outreach efforts since state government has a limited role.

"If the plans are going to be available, whether you agree with the Affordable Care Act or not, we should be enrolling people in them because they're available," state director Lonnie Scott said.

Volunteers are knocking on doors and making phone calls to direct the uninsured where to go in a campaign not all that different from a political operation. Enroll America has street-level data showing the likelihood of a household having insured or uninsured occupants on a 1 to 100 scale. The group will evaluate how it did next spring but plans to be in Michigan two to five years.

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Email David Eggert at deggert@ap.org and follow him at http://twitter.com/DavidEggert00