With just a few weeks remaining before the gate closes on Minnesotans' ability to buy health insurance for 2014, a full-court press is underway to sign people up for coverage.
Health fairs are being held at schools, churches, libraries and community centers. Signs are plastered on billboards and city buses. And a steady drum beat of reminders are going out on radio, TV, Facebook and Twitter, as insurance leaders and social service agencies work feverishly to break through confusion and apathy to get people insured before the end of March.
"We've turned up the volume up to 11," cracked MNsure interim CEO Scott Leitz, who announced a "March to Enroll" campaign last week of more than 650 sign-up activities statewide.
The urgency comes as a bevy of surveys indicate that as many as three-quarters of uninsured Americans remain in the dark about the approaching March 31 deadline, after which people will face penalties if they lack coverage.
Many people don't realize they won't get another chance to buy insurance until November, even if they want to.
"Not a lot of attention has been paid to that," said Dannette Coleman, a Medica vice president. "We think that message is critical and a bigger motivator to get health insurance coverage than a $95 penalty."
The crunch has started
The crunch has already started on the front lines. At an enrollment event last week in the gym at the Brian Coyle Community Center in Minneapolis, a dozen people waited an hour or more for the chance to work with a certified MNsure navigator.
Halimo Khalif, who was No. 11 in line, said she didn't mind the wait. Originally from Somalia, she lost her health insurance when she got laid off from a job she'd held for nine years. She started the sign up process on MNsure on her own, but got confused and created multiple accounts.
"I tried to do it myself, but it didn't work," said Khalif, 40.
But soon, she and navigator Mary Pargo were looking at a laptop computer and cheering.
The fair was one of five to be held this month around Minneapolis through Pillsbury United Communities, which brings in multilingual navigators.
More than 113,000 Minnesotans have bought coverage through MNsure, the state's online insurance exchange. But that lags far behind original estimates, in part because the website was crippled by chronic technical issues during a key sign-up period from late November to the end of December.
Now, the pressure is on to make the next three weeks count.
Of the 490,000 uninsured Minnesotans, about 60 percent are eligible for public programs, and tens of thousands more are eligible for tax credits available only through the MNsure website.
MNsure officials are relying mostly on an army of insurance brokers and nearly 1,400 certified navigators to reach across the far corners of the state in the weeks ahead. Its radio and TV campaign soon will begin underscoring the March 31 deadline.
MNsure troubleshooters also are working through a backlog of people whose problems may have started when the site was hobbled late last year. Most people who run into complex problems now will get a call from MNsure within 24 to 48 hours to complete the sign-up process, Leitz said.
Insurance companies and community groups are trying new ways to reach the uninsured. They're using social media to find young people, holding meetings in church basements, sponsoring running events, or showing up at food shelves.
Medica recently rolled out a new tongue-in-cheek campaign it calls "No Regrets," that features unicorn tattoos and drive-through weddings to convey a sense of security from having health insurance.
HealthPartners created a special help desk to help people figure out whether they're eligible for tax credits, going so far as to identify the relevant line on tax returns, said Andrea Walsh, the insurer's executive vice president and chief marketing officer.
Call center operators have even patched new members into three-way calls with insurance exchange staff in Iowa and Nebraska to help them get tax credits.
"It requires a lot of hand-holding," she said. "Unfortunately health care is complicated, and anything with taxes is complicated. So we're trying to unpack that and make it simpler."
While mass media campaigns and balloon-filled health fairs get the word out to many people at once, the real work happens in lengthy, one-on-one meetings that can take days to resolve — all of which adds to the deadline crunch.
"It's a delicate, high-touch process that involves sensitive information," said Julie Ann Eastling, of the Blue Cross and Blue Shield of Minnesota Foundation, which has given $1 million to community groups to help get insurance for difficult-to-reach populations in urban, rural and immigrant communities.
"It sometimes requires documentation and tracking down paperwork," she said. "It can take a lot more than a one-hour session."
St. Paul-based Portico Healthnet used a grant from the Blue Cross Foundation to roll out a mobile phone text system in January that nudges people to get health insurance applications completed.
A message might ask, "Have you picked a plan yet?" Or it could offer a reminder about an upcoming appointment.
Rebecca Lozano, who manages the organization's outreach programs, said texting allows Portico Healthnet workers to communicate in Spanish to address its large Latino population, and to avoid phone tag or wasting time tracking down people who have moved.
On any given day, the messages go out to 1,200 people, she said. "We get cases that other organizations don't know what to do with," she said. "They require a lot of follow up."
Many problems are due to inherent problems in the way the MNsure site was built, she said.
For example, because the online form is only in English, translators are needed to help new immigrants. And there's no online pathway to help an undocumented parent buy coverage for children who are legal residents, as the immigration hub doesn't sync up with the federal hub, making verification time-consuming and confusing, Lozano said.
Many groups pushing for enrollment feel as if they have their backs against the wall.
At Pillsbury United Communities, even when 10 navigators show up at an event, there's always a line, said spokesman Alan Berks. "The need and the desire is really great," he said.
Managers at Portico Healthnet are developing an overtime policy for the first time in the organization's history because the workload has become so demanding.
The organization has signed up more than 2,300 people through MNsure since the start of open enrollment in October, and has spent hours training new MNsure navigators on unique challenges of reaching those who are homeless, who have never been insured or who have disabilities or language barriers.
Its 12 navigators are working evenings and weekends to help as many people as possible meet the March deadline
"We're just running out of time, said Lozano. "There are not enough hours in the day to do the things we need to do."