Showdown in Texas over new insurance sign-ups

Politico —

HOUSTON — The ground war over Obamacare — the one that will determine
whether people sign up — will be won and lost in places like Texas.

If Obamacare fails in the Lone Star State — that is, if a significant
portion of the 6.1 million uninsured Texans don't or can't enroll —
then the White House could miss its national enrollment targets, the new
health insurance exchanges could falter and insurance rates could
spike.

Obamacare could be unsustainable.And that's exactly what leading
Texas politicians like Gov. Rick Perry and Sen. Ted Cruz would like to
see happen. With the political leaders' “hell no” approach to Obamacare,
Texas may not seem like a health law battleground. But the demographics
— a huge, hard-to-reach uninsured population — mean it's a
make-or-break state for making the law work.

Advocates are banking on the idea that a grass-roots push in more
liberal, urban areas of Texas, plus the demand among the uninsured to
get health coverage, will overcome the state's institutional opposition
and deliver on the promise of Obamacare.

“Some of my friends on the other side of the aisle are doing as much
as they can to make it difficult for this program to work,” state Sen.
Rodney Ellis, a Democrat from Houston and prominent supporter of the
law, said as enrollment began a few days ago. He thinks the Republican
strategy will backfire. “One more election cycle and all of this is
going to go away,” he predicted.

The challenge for Ellis, Houston and all of Texas is “to get the word out” about the law, he said.

Texas has the highest uninsured rate in the country — about one in
four people lack coverage, and one in three Hispanics. Perry's
administration didn't expand Medicaid under the law to cover more poor
people, which the Supreme Court made optional.

And it spurned the state health insurance exchanges. So here in the
Lone Star State, where resentment of federal interference runs strong,
the U.S. government and its allies are stepping into the breach.

The best hope of Obamacare backers is to support the efforts of local
allies in regions such as Houston, Dallas and Austin, the bluest areas
of a deeply red state. That's because these areas lean liberal and also
have an existing network of progressive activists.

The Obama administration sent Texas nearly $11 million — more federal
grant money than any other state — to fund “navigators” who are trained
and tasked with helping people through the sign-up process.

In Houston, with 1.4 million uninsured residents, city officials are
modeling their efforts on hurricane-force emergency response to counter
the adamant state opposition, said Stephen Williams, director of the
Houston Department of Health and Human Services.

“We believe this effort is so critical that we have created an
incident command structure,” Williams said. “This is the same structure
that we use to respond to hurricanes and to respond to public health
disasters.”

The city of Houston has provided free office space to Enroll America,
a nonprofit group closely associated with the former Obama campaign
that is now spreading the word about the health law. The city has
provided at least 55 people to help residents enroll and created space
for a phone bank.

It has ordered public library computers to have links to enroll
access and it's even printing Obamacare information on local water bills
“so the broader population can all be informed,” said Mayor Pro-Tem Ed
Gonzalez, a Democrat.

That stance is a striking contrast with Texans on the national stage.
Cruz, for instance, helped push the government shutdown over Obamacare,
and now he's urging that the GOP link its demands for health law
changes to the debt ceiling fight that will peak in mid-October.

“The debt ceiling historically has been among the best leverage that
Congress has to rein in the executive,” he said on CNN's “State of the
Union” on Sunday, adding that leverage should be used with the
Democratic health law.

But here, some people are eager for the promised coverage.

Houston resident Reynoldo Gutierrez went on Tuesday, the first day of
open enrollment, to a sign-up event. His experience was typical of the
technical glitches that snarled computer systems across the country. The
55-year-old patiently tried again and again to log onto HealthCare.gov
using a laptop at a Houston sign-up event.

He wanted to get coverage for his wife. All he got were messages that said “please wait.”

“I'm just trying to get enrolled in this health insurance, and I have
to wait,” he said matter of factly, determined to complete the sign-up
process when he can. “I have no choice.”

Enroll America has made Texas a priority, too.

“Our database is sophisticated,” said Mario Castillo, who is leading
Enroll America's efforts in Houston and the Gulf Coast region. “We can
target uninsured individuals, where they live, what neighborhoods, what
precincts.”

The group then helps link the uninsured up with navigators or
counselors who can walk them through the application process. “We don't
want anyone slipping through the cracks,” Castillo said.