Hundreds of thousands of previously uninsured Texans have signed up for health insurance since the federal government began requiring it last year.
Still, Texas continues to have the highest rate of uninsured people in the country. The state doesn’t spend any money to promote the federal health insurance marketplace under the Affordable Care Act.
Last year, nonprofits spent much of the enrollment period educating people on the ACA. Their efforts were slowed by the botched rollout of the healthcare.gov website. In the second year of the insurance marketplace, some Texas nonprofits are changing their strategy, and insurers, hospitals, and city governments are also doing more to help people enroll.
Last month, at a Target store in San Antonio, a generator drowned out the sounds of shopping carts and cars parking as it powered a massive blue RV.
"This year as part of our open enrollment efforts, Blue Cross Blue Shield of Texas put forth this RV," said Edna Perez Vega, a spokesperson for Blue Cross Blue Shield of Texas. "It is a fully functional mobile site for people to get education and information about health insurance."
The company hopes many people will come get informed and sign up for health coverage in the RV.
"We want to meet people where they are, where they live, and where they shop," Perez Vega added.
That convenience factor isn’t lost on the people walking by on their way into Target – people like Yvonne Garcia, who spoke to insurance agent Carlos Guerra before eventually making her way into the store. Garcia said that she’s a contract worker without health benefits.
"So I need to purchase them on my own. If I go through my husband’s work, it’s extremely expensive," she said, and Guerra then walked with her to the RV where they could discuss her health insurance options.
Blue Cross is focusing its efforts on getting people who qualify for a plan on the federal health insurance marketplace onto one of those plans. Many of those customers qualify for tax subsidies.
Enrollment numbers are higher in Texas in this second year. As of Jan. 9, almost 860,000 Texans have signed up for a plan on the marketplace – already more than 100,000 people more than the last enrollment period.
"We have seen a whole lot of organizations and entities ramp up their support for outreach and enrollment in this second enrollment period," said Anne Dunkelberg, a health policy expert and director at the Center for Public Policy Priorities, a left-leaning think tank in Austin. She said all of the organizations involved in outreach under the ACA, from private insurers to hospital systems, stand to absorb a lot of costs for the uninsured.
"Everything that can happen in the marketplace that helps spread the risk a little further can help bring the average costs down," Dunkelberg said.
Grassroots efforts in Texas have changed some this time around to keep getting people enrolled until the Feb. 15 deadline. Some are choosing to host major events in February, near the end of the enrollment period, after lessons learned last year.
For the first time, Austin nonprofit Latino HealthCare Forum is getting funding from the City of Austin and access to city facilities.
"This was a first for Austin," said Frank Rodriguez, the executive director of the Latino HealthCare Forum. "Last year the city did not fund any activity and I think they came to the realization that they play a central role in the community’s health care.”
One upcoming enrollment event will be at City Hall in downtown Austin.
"We felt like we needed to be downtown to really do some outreach with the service industry workers, the folks that work at restaurants, construction workers," Rodriguez said.
Despite city funding, however – $300,000 combined for the Latino HealthCare Forum and another nonprofit, Foundation Communities – Rodriguez knows Latinos are hard to reach.
"I still think we’re still gonna just do some bite size pieces in this," he said. "This is still a chronic, long-term issue for the community, and we’re gonna have to keep working on it."
Olga Rodriguez (no relation to Frank), the deputy director of the Texas Association of Community Health Centers, said community health centers are still seeing uninsured people in droves.
"Of the 1.2 million clients or patients that Texas health centers see each year, approximately 70 percent of them fall under 100 percent of the federal poverty level," she says.
That means they don’t qualify for subsidies for an ACA plan, and because Texas hasn’t expanded Medicaid eligibility so far, they don’t qualify for that program, either.
"In terms of the applications being submitted, we’re consistently seeing that a lot of people are being told they’re too poor to receive assistance for health insurance and fall under the coverage gap," Rodriguez said.
Back at the Target in San Antonio, customer Yvonne Garcia comes out of the Blue Cross RV after almost an hour. She didn’t qualify for an ACA plan, based on her income, but she did sign up for health insurance.
"We just by chance came to do some shopping and, wow. I said ‘Oh my God' – I told my husband – ‘it’s Blue Cross and I’m gonna have to get it.’" she said, adding that she could finally make her way into the Target for her shopping.
Blue Cross is taking its RV to Target stores and H-E-B supermarkets across South Texas, to cities including Corpus Christi, Laredo, and Brownsville. Those areas are heavily Latino – and uninsured.
This story was produced as a project for The California Endowment Health Journalism Fellowships, a program of the USC Annenberg School for Communication and Journalism.