MCALLEN, Texas — With less than two months remaining to enroll in the health care marketplace, the federal government is focusing outreach efforts on areas with the largest concentrations of uninsured, including Texas' Harris and Dallas counties.
According to a study conducted for The Associated Press, half of the nation's uninsured live in just 113 of the 3,143 counties. Texas has the highest uninsured rate in the U.S. — about one in four people — and the two biggest concentrations in Texas are Harris and Dallas counties. That sort of data are what brought U.S. Health and Human Services Secretary Kathleen Sebelius to Dallas last week and why the agency is coordinating with Houston health officials on advertising aimed at spreading the enrollment message.
Martha Blaine, executive director of the Community Council of Greater Dallas, said Texas' refusal to expand Medicaid is the main factor.
"I think the other reason that we're not making the headway against the uninsured in Texas is that ... with the federal exchange Texas did not receive any of the outreach money. And so we do not have high-profile outreach programs like California has," Blaine said. "The general public does not have a unified message in Texas."
Federal officials have identified 25 key metro areas to focus on before the March 31 end of open enrollment, including Dallas and Houston; South Florida and Orlando; the northern New Jersey megalopolis; Phoenix and Tucson; Detroit and Cleveland; Atlanta and Nashville. In mid-January, federal officials reported more than 118,500 Texans had used the health care web site to sign up for insurance.
Texas poses a couple of challenges. The state has many immigrants who are in the country illegally and therefore are not eligible for subsidized health coverage through the marketplace, and it didn't expand Medicaid to cover most poor adults.
Debra Walker, 59, of Houston, who has lived without insurance for the past few years, falls into the latter category. She cares for her sick husband and in order to have the flexibility she needs she works as a home health care specialist about 20 hours per week. She makes $7.50 per hour.
For the past three years, Walker has relied on Harris County's health plan, which subsidizes doctor's visits on a sliding scale based on a resident's income. Still, with recent diagnoses for high blood pressure and diabetes, even her reduced prescription costs can add up.
"It's pretty hard to swing that," Walker said. "It gets expensive."
For the AP study, the State Health Access Data Assistance Center at the University of Minnesota used government data from the 2011 Small Area Health Insurance Estimates, the only source of annual estimates of uninsured people for all counties. They were not able to filter out people who entered the country illegally and thus are not eligible for coverage under the law.
Benjamin Hernandez, deputy assistant director for the Houston Department of Health & Human Services, said it's little surprise that Harris County's nearly 1.1 million uninsured rank it second only to Los Angeles County. The city has been using ZIP code-level data of the uninsured but is still seeking updated information that would show where their outreach is actually leading to enrollment in those areas.
"We've done a lot of grassroots efforts ... but we have not had a lot of media penetration in this market," Hernandez said.
"We're paying currently for our own media buys that we're doing in (public service announcements), but ... we're working with HHS now so they can do some media penetration in this area as well."
Enroll America and the Ad Council launched commercials this week that feature singing pets encouraging their owners to get coverage. The ads target uninsured women between the ages of 18 and 34.
But Mimi Garcia, Enroll America's director in Texas, said they've found in-person contact to be key.
"The truth is what we've found is that people don't move to go get covered because of something they see on TV or something they hear a celebrity say, but it really comes down to the individual person-to-person conversation," Garcia said.
To that end, Enroll America plans a major volunteer training blitz in six Texas cities, including Dallas and Houston, on Feb. 22.
Associated Press writer Ricardo Alonso-Zaldivar in Washington contributed to this report.