WASHINGTON -- As Obamacare emerges from the rubble of its first two months, local organizers, state officials and the White House see a clear path forward. With the website now quasi-functional, there are good reasons to believe that the Affordable Care Act will catch on. Quite simply, there are tens of millions of uninsured people who want health insurance, a law in place to help them obtain it, and advocates on the ground making sure they know how to do it.
For on-the-ground organizations, Obamacare represents a once-in-a-generation organizing opportunity. By signing someone up for health insurance, they are delivering a tangible benefit, something that person will value for years to come, and winning loyalty along the way. Nonprofits, as well as mayors and governors, have an intense incentive to make Obamacare work.
And millions of those uninsured people -- many of them young and healthy -- are in tightly concentrated urban areas, target-rich environments for the grassroots groups and politicians working to sign people up.
Take Los Angeles County. More than 2.2 million uninsured people live there -- nearly 5 percent of the entire country's uninsured population. In the Houston metro area, there's Harris County with more than 1.1 million uninsured. Add in Cook County, which includes Chicago, and Miami-Dade County in Florida, and the numbers of concentrated and targetable uninsured quickly add up.
The importance of these counties to Obamacare's success is not lost on anyone. "California is ground zero for this," said Steven Abramson, a marketing manager for the Community Health Alliance of Pasadena. "And LA County is ground zero for California."
Abramson said his group and other local clinics will be augmenting their enrollment events and outreach efforts with a new initiative called Cover LA, which launches in December and will include videos being played on transit buses to promote a website and call center. The website will let residents search for enrollment events by zip code.
Manpower is being ramped up across the county. Covered California, the state's health insurance exchange, has 448 navigators operating in Los Angeles County with an additional 1,300 in the process of being certified, said the exchange's Larry Hicks.
In Texas, the focus is on those counties with the most uninsured. Tiffany Hogue, the health care campaign director with the Texas Organizing Project, said that of her group's 12 community organizers, seven are working in Harris County. Another three are in Dallas County along with the project's statewide organizing director. Given the number of uninsured in those two areas, Hogue said their importance is obvious.
SEIU-United Healthcare Workers West, which counts some 150,000 hospital and nursing home workers and home care aides as members, has also targeted LA County. With the help of a grant from the California Endowment, the union had started enrolling the uninsured who will qualify for the state's version of Medicaid (known as Medi-Cal) before the Oct. 1 Obamacare rollout.
Sean Wherley, spokesman with SEIU-United Healthcare Workers West, said the union has signed up 3,000 for Medi-Cal so far. Most of them are in LA County, he said, and many come from a single neighborhood, Boyle Heights. "It's kind of the target demographic -- Latino, uninsured, but eligible to be insured," said Wherley.
Because of the geography of poverty, one gathering can make a real dent in the uninsured population. One event in Sacramento was attended by 1,500 people. "Almost 500 started the enrollment process in Obamacare," said Wherley. "They had 300 volunteers at the event."
The concentration of America's uninsured is central to the administration's optimism. For months, senior White House officials have been reminding reporters in briefings about the millions stacked up in Los Angeles, Chicago and other easily accessible urban areas.
The White House is using its power to generate media interest to shine a light on those areas. In recent weeks, top administration officials have visited Los Angeles, Chicago, Dallas, Houston, Miami, Atlanta, Phoenix, northern New Jersey, Tampa, Orlando, Detroit and San Antonio, home collectively to more than 7 million uninsured. The visits generate press coverage and elevate the on-the-ground organizing efforts.
Health and Human Services Secretary Kathleen Sebelius hit Phoenix on Oct. 24 and San Antonio the next day. Three days later, top White House health care official Cecilia Munoz visited Detroit for an event that connected navigators with residents. The next day, Agriculture Secretary Tom Vilsack stopped in Atlanta to tout Obamacare.
The following week, Obama himself visited Dallas, and Housing and Urban Development Secretary Shaun Donovan went to Tampa.
These Obamacare visits to uninsured hot spots are reinforced on the ground, like campaign stops, with a coordinated effort among unions and nonprofits doing local outreach. "We approached it much like you would a political campaign with mailings, door knockings, repeated attempts. And phone banking," Wherley said. "You need to hit people multiple times from multiple formats. One to get them, two to help them understand how this works and get them to an event where they can actually enroll." The union created a nonprofit to do the Obamacare outreach.
Mariaelena Querales is one of those LA County organizers on the other end of the phone or knocking on the door or greeting people at Obamacare events. She told HuffPost that supervisors have broken down the outreach into four zip codes and that she has been assigned specific areas to cover within one zip code. She estimates that she has talked to 2,000 residents on her own.
Mostly the outreach involves education. "A lot of people don't understand what ACA or Obamacare is," Querales said.
People are naturally skeptical when someone knocks on their door offering a service, said Noemi Caraveo, 22, a Community HealthCorps member through AmeriCorps. "It's just a matter of getting their trust," said Caraveo, who's working in LA County. "I tell them I'm just trying to help, I'm not getting any commission. Once that happens, they are more like, 'OK.'"
Mimi Garcia, the Texas state director with Enroll America, sees her operation in much the same way as her counterparts in Los Angeles. The Texas outreach campaign launched in June with the view that both Harris and Dallas counties were key, Garcia said, adding that the campaign has made the Obamacare pitch to thousands in those counties.
"We've done a lot of door knocking and canvassing," Garcia said. "In Dallas, we have worked a lot with the black Baptist churches and the Hispanic evangelical churches to have info sessions on Sundays and Wednesdays, working through the congregations themselves to build up volunteer teams."
In Houston, the health department gave Enroll America a temporary office in its building. Kathy Barton, chief of public affairs with the Houston Health Department, said that the group is helping to map where the uninsured are. But she added this caveat: "We haven't had a lot of enrollment because of the problem with the website."
Unlike California, Texas did not create its own health insurance exchange. Nor did Gov. Rick Perry (R) provide a dime in state funding for Obamacare outreach. Instead, public health officials in Houston and nonprofits have sponsored some 170 events, Barton said.
But all the organizing and community outreach in Texas, and many other Republican-controlled states, will necessarily fall short of Obamacare's ultimate goal. Since Perry has refused to expand Medicaid, many in the state will still be unable to afford health insurance
"It's going to be really sad that there will be a significant number of people we will not be able to help," Barton said.