The key is to go beyond mass advertising to talk with people in their churches, workplaces and neighborhoods, MacDonnell said.
Another effort in Florida to reduce the uninsured, JaxCare, also suffered from low enrollment. JaxCare, which started in Jacksonville in 2004, was marketed as low-cost coverage for small employers. Employers could get low-income workers covered for $50 a month. But two years after it began, fewer than 500 people had signed up, or less than a third of those projected. JaxCare, which closed in 2008 when city funding ran out, did reach its goal of covering 1,500 people, but it took nearly four years.
Former JaxCare chief executive Rhonda Poirier said one of the lessons was that many of the people the effort sought to reach knew little about coverage, so advertising on television did not resonate with them. “We found the outreach has to be much more personal, whether it’s through their business, church or other community organizations,” she said.
Another challenge was persuading insurance agents to get involved in selling the program to small employers. Agents were skeptical of the program because it did not have one of the major insurance carriers behind it. Many exchanges under the federal law plan to work with insurance agents, though details are still being worked out.
JaxCare also discovered that some employers were not willing to provide coverage even at heavily discounted levels.
“I remember one employer telling us he wasn’t interested unless we would give it away for free,” Poirier said.
Meanwhile, Vita Health in Palm Beach County did boost enrollment over time, especially after the program expanded eligibility to cover everyone under 300 percent of the federal poverty level, or nearly $35,000 for an individual, who did not have coverage for at least six months. An estimated 250,000 people are uninsured out of about 1.3 million county residents.
Today, seven years after the program began, about 11,000 people are enrolled (although the program ends at the end of this year when the health law is implemented).
Tom Cleare, chief program officer for the Palm Beach County Health Care District, said Vita Health’s monthly premiums were based partly on what focus groups said people would pay for coverage. But price was only one issue that kept people from signing up. The bigger problem was convincing people they needed coverage.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.