With just four months until the state’s health insurance exchange opens for enrollment, a coalition of Orange County community organizations and health clinics said they won’t have the funding to do crucial outreach and education to the county’s estimated 280,000 medically uninsured.
Last month, Covered California, the state agency tasked with rolling out the insurance exchange, awarded $37 million in outreach grants to 48 organizations across the state, including at least five organizations with statewide campaigns reaching Orange County.
But three local coalitions applying to do outreach targeting Orange County’s uninsured were all rejected, leaving community leaders searching for the reasons.
The rejected applications include community nonprofits and health clinics that provide social safety net services to Latino, Korean, Iranian and Vietnamese communities, to family health care groups, to seniors and to Medi-Cal patients.
“We’re stunned and confused,” said Alan Woo, director of planning at the Community Action Partnership, one of the three leading organizations that applied for funding. “It just seemed strange that three really strong organizations that have already been involved with assisting the uninsured did not get approved.”
According to the funding rules, local organizations were able to join one application for funding. While a few local groups, such as the Orange County Asian and Pacific Islander Community Alliance or OCAPICA, applied with statewide organizations, most decided to join Covered OC, a collaboration of more than 30 Orange County nonprofits seeking nearly $3 million in funding.
Local organizations were restricted to one application to reduce the burden of monitoring and reporting how funding is used.
“The [grant] process was flawed, win or lose,” said Ellen Ahn, director of Korean Community Services, a local group serving uninsured Koreans. "All the small nonprofits, all the community clinics, everybody — almost everybody — was at the table aligning themselves with a local grantee collaborative. We all made an incorrect gamble.”
A few groups in the county did receive funding. The Anaheim Health Medical Center and Access California, an Arab- and Muslim-American community group, each received $500,000 to do multi-county outreach. OCAPICA, which works with Latino and Asian-Pacific Islander populations, will get a slice of the $1 million awarded to the Asian Pacific Legal Center for work in 10 different counties. Outreach will otherwise be split among a few organizations doing work in multiple counties.
But, said local leaders, the outreach will not be as effective without participation from the organizations that have deep ties to the ethnic and underserved communities most in need of the education.
“When Healthy Families came out, we served close to 218,083 people," said Woo. "We continued even after we lost funding to reach out to people. If that’s not a proven record, than what is?”
Deep Community Roots
Ethnic community groups like Korean Community Services, Latino Health Access and the Vietnamese Community of Orange County are already well-respected in the community, said Ahn.
“We have the infrastructure, the relationships, the community respect — we're part of the fabric of the community,” said Ahn. “It’s not just about hiring staff who speak Korean, it’s about being a trusted source. We have a captive audience of uninsured Koreans. For another agency to come in, it wouldn’t be as effective.”
Mai-Phuong Nguyen, a physician, health care advocate and the host of a Vietnamese-language radio show about the Affordable Care Act, said a grassroots approach is essential to incorporating ethnic communities into a system that is, at least in theory, broad and inclusive.
“A lot of ethnic communities have great reservations and hesitancy to be accepted as part of the mainstream because we’re used to being a part of the margin,” said Nguyen. “The word is distrust at times. The Affordable Care Act is different, because its says, you’re a part of this and you’ve got a seat at the table.”
But both Ahn and Nguyen said the level of awareness in underserved communities about the Affordable Care Act is still very low, with relatively little coverage in the ethnic media. Over the year that she has been broadcasting her radio show, Nguyen said maybe two people have called her with questions about the act — both of them providers.
Nguyen criticized Covered California for taking a “top-down, mainstream” approach that she said won’t be enough to penetrate ethnic communities. Covered California does plan to dispatch counselors into ethnic communities to educate and enroll the uninsured.
“Their approach is, 'We’re going to translate this into 100 languages and assume this is going to make [outreach] culturally sensitive and culturally competent,' ” said Nguyen. “My hope is that they will truly dig into communities and partner with reputable, community-based organizations, and not be shy about partnering with ethnic media.”
Much is at stake for the outreach effort.
According to a March 2013 poll by the Kaiser Family Foundation, 48 percent of Americans report hearing “nothing at all” about their state’s decision on whether to create a state-run insurance exchange.
But come January 2014, the penalty for the uninsured will be $95 or 1 percent of annual income, whichever is higher, with a much heftier fee kicking in by 2016.
Ahn said that lack of knowledge is worsened in ethnic communities where a large part of the population has limited English skills. In a 2006 survey by the U.S. Census Bureau, 56.2 percent of Koreans reported speaking English “less than very well.”
Orange County Singled Out?
Covered OC has requested formal feedback on its applications. Covered California representative Larry Hicks said it is part of their policy not to discuss individual grant applications.
According to the funding criteria, successful proposals would incorporate in-person, in-depth education efforts targeting those newly eligible for insurance. Statewide strategies were “highly considered” because of their broader reach, Hicks said.
Yet, said leaders of the Orange County groups, grass-roots coalitions in other counties did receive funding.
“Everywhere other than [Orange County], they took the grass-roots approach, and that’s why we questioned what happened,” said Isabel Becerra, CEO of the Coalition of Orange County Community Health Centers or COCCC. “We're very concerned about the number of individuals that will be left uninsured.”
Hicks said that those who didn’t receive funding may apply to become "assister enrollment entities" to help enroll individuals in the state insurance exchange or may join a community outreach network.
“Right now we are encouraging local organizations to get involved in our community outreach network [for] those who are committed to bringing affordable healthcare to their constituents,” said Hicks. “Many have expressed an interest of working with us regardless of if they're being compensated.”
A remaining $6 million will be distributed in 2014, but only to health care professionals and existing grantees based on the success of their outreach strategies.
“We have adequate statewide coverage, so there isn’t a need to recruit additional organizations,” said Hicks.
Woo speculated that a reason the local coalitions may have been shut out is a misinformed view that all of Orange County is affluent with few unemployed or needing assistance.
“It may be that in Sacramento they don’t understand that while we do have an affluent community, Orange County has low-income populations as well,” said Woo. “Issues of equity and fairness come to mind. Why is it we always get passed over for Los Angeles and San Diego [counties]?”
Fears of Big Insurance
While groups wait for statewide grantees to begin rolling in Orange County, Woo is worried that marketing by private insurance companies may reach consumers first.
“The whole point of outreach is to provide impartial information to help people try to figure out what’s going on,” said Woo. “What chance to ordinary poor folks have with the onslaught of big marketing dollars being spent?”
With or without funding, Covered OC continues to meet regularly to identify organizations that did receive funding and strategize ways to leverage those resources. Most groups plan on incorporating education about the health insurance exchange into their English classes, health exams and daily interactions with the public.
“We're still continuing [outreach], whether Covered California is supporting us financially or not,” said Lois Kim, grants coordinator at Latino Health Access. “It’s still a mission for our organization and other funders.”
OCAPICA, one of the few Orange County nonprofits that applied under a statewide proposal and received funding, initially planned a concentrated education campaign focusing on minority communities, said executive director Mary Anne Foo.
“But once we found out that no one got funded, we started to think about how we can reach out to a lot of different folks and continue to do [outreach], even though there is not a lot of resources,” said Foo.
Their new strategy aims to reach 15,000 uninsured residents of many different backgrounds in every supervisorial district in the county.
But Foo said that with limited time and resources, small, underserved communities might still fall through the cracks. For example, Costa Mesa is home to a significant population of Marshallese, an ethnic group from the Marshall Islands.
“The folks that might get left out are smaller populations with English as a second language, like Hmong or Marshallese … [for whom] a lot of materials aren’t translated,” said Foo.
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