With Trump Cuts, Obamacare Enrollment is a Volunteer Affair in Rural Texas

In Bastrop County, advocates have about $100 to get the word out to tens of thousands of Texans.

Ginger Redden (center, left) and other Bastrop County Indivisible volunteers brainstorm ACA outreach at the Smithville Public Library.
Ginger Redden (center, left) and other Bastrop County Indivisible volunteers brainstorm ACA outreach at the Smithville Public Library. Sophie Novak

In a back room of the Smithville Public Library, Ginger Redden passes around a donation jar to the volunteers gathered around the conference table. They take turns dropping coins and a few bills into the container, which is labeled “Lucky Pennies.” It’s November 1, the first day of open enrollment for health insurance through the Affordable Care Act, and all the funding to spread the word in Bastrop County is contained in the jar. So far, they’ve raised just over $100.

The group’s work is a direct response to attempts by President Trump to single-handedly dismantle the Affordable Care Act. After Congress failed to repeal Obamacare this year, Trump cut funding for advertising nationwide by 90 percent, slashed the budget for in-person assistance by 34 percent in Texas and cut the enrollment period in half.

“Ordinary people are doing the government’s job because Trump is trying to sabotage the ACA,” said Redden, a volunteer organizer with Bastrop County Indivisible, which is part of the progressive Indivisible movement that erupted in response to Trump’s election. It’s a job that’s particularly difficult in rural areas of Texas such as Bastrop County, home to 83,000 Texans. Redden and other volunteers are contending with spotty internet, few resources and a community that’s largely misinformed or reticent to utilize Obamacare. Just one location in the county, the Lone Star Circle of Care clinic, has ACA “navigators” who offer free help enrolling in health insurance. “We really have to go low-tech,” said Redden. That means volunteers posting fliers on community bulletin boards as well as in libraries, city hall, health clinics and churches.

“We’re in such a difficult place in Texas because the state doesn’t support people getting enrolled at all, either philosophically or financially,” said Lisa Goodgame, who is president of Indivisible Austin and works on communication for Cover Texas Now, a coalition of advocacy organizations working on boosting insurance coverage around the state.

Texas has the highest uninsured rate in the country, but the state rejected a Medicaid expansion under the ACA that would have covered more than 1 million Texans. Governor Greg Abbott has repeatedly called for the repeal of the health care law.

“Other states might be picking up the slack for missing funds, but Texas is not going to do that,” Goodgame said. “There’s really no money coming from anywhere for this.” The groups are recruiting a small army of volunteers, mostly clustered in cities, to help with ACA outreach.

ACA enrollment fliers  Sophie Novack

ACA enrollment volunteers around Texas are focused on five main messages: The ACA is still alive and well; financial help is available; the enrollment window is from November 1 to December 15; in-person assistance is still available; and everyone needs to shop around for coverage to find the best deal.

“Our biggest challenge right now is that there are so many misconceptions,” said Melissa McChesney, who works on health care policy for the left-leaning Center for Public Policy Priorities, which is part of the Cover Texas Now network. A recent national poll from the Kaiser Family Foundation found that just 15 percent of the uninsured know when open enrollment begins. “There’s a lethal combination of things: People are not sure the law is there; they have only six weeks to enroll; there are not funds or resources to get the word out that the law is still here and affordable for people,” McChesney said.

Simply figuring out where to do outreach has proved challenging. Bastrop County volunteers are targeting high-traffic areas with signs and fliers. At the library meeting, the volunteers celebrate a minor victory — the Walgreens is allowing a stack of fliers at the pharmacy register.

One man suggests asking at the local hospital.  “Quick, while we still have one,” a woman responds.

The Dollar Store? “They’ll shut us out.”

A thrift store run by nearby churches? “I don’t expect to get a yes.”

The advocates wish health insurance wasn’t political, especially since one in every five Bastrop County residents is uninsured, twice the rate of the United States overall. But in the solidly red Texas county where Trump won with 57 percent of the vote, it’s hard to separate Obama’s name from his signature policy. “We go to school, church, work, with people that also see us on the bridge protesting,” said Michelle Rutherford, a volunteer with Bastrop County Indivisible. “We have to be concerned about our safety when we do outreach.”

The group jokes like old friends, but they’ve only just met after the election last year. The volunteers have come out of the woodwork to form a kind of underground progressive community, ready to fight anything the Trump administration throws their way. ACA outreach is just the latest challenge.

“It’s all part of the resistance,” said Robin Rieck, another volunteer. “They try to sink it, we’ll try to save it.”

Sophie is the public health reporting fellow at the Observer. She previously covered health care policy and politics at National Journal in Washington, D.C. You can contact her at [email protected].

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Published at 3:47 pm CST
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