PICO NATIONAL NETWORK
BRING HEALTH REFORM HOME:
ENROLLMENT AND OUTREACH
2
PICO NATIONAL NETWORK
BRING HEALTH REFORM HOME:
ENROLLMENT AND OUTREACH TOOLKIT
CONTENTS
What is enrollment?
Page 3
Why does it matter?
Page 3
PICO’s Role
Page 3
How does it work? ACA Basics
Page 5
Funding
Page 7
California Model
Page 7
What are the benefits?
Page 9
Federation check-list
Page 10
Levels of Engagement
Page 11
Timeline
Page 12
Obama signing the
Affordable Care Act
What is the enrollment program?
PICO National Network worked hard to bring the voice of low-income families into the heart of the
PICO National Network ▪ Unlocking the Power of
People www.piconetwork.org
171 Santa Rosa Avenue ▪ Oakland, CA 94610
Phone: 510 655 2801 ▪ Fax: 510 655 4816
3
healthcare reform debate. The campaign and resulting policy were grounded in our common values of
healthcare coverage for all, a continued investment in the public good, and building more power and
agency for our communities to act. To continue this movement for health and community power we
must enroll all of our eligible congregants for coverage and continue to build robust vehicles that
increase civic engagement. We are launching the enrollment campaign to bring all the benefits of the
Affordable Care Act home, while seizing the opportunity to increase civic engagement, and continue to
live out our deep belief that we must invest in the public good so that everyone can thrive.
Starting October 1st, 2013, 25 million Americans will become eligible for new healthcare coverage. In
partnership with health facilities and allied community groups around the country, PICO National
Network will work with our federations between now and October 1st to assist in outreach and ensure
that the maximum number of people in our congregations and communities are enrolled. Our work will
be to channel our networks to our enrollment partners while seizing the easy opportunity to build our
base, develop our leaders, build our capacity for civic engagement, register voters and empower our
community.
Passing the health reform was Act I. Enrollment and outreach is Act II. It will be nowhere near as intense
and capacity consuming as passing the ACA. This is the fifth spoke in our organizing model: listen,
research, action, reflection, implementation.
Why does it matter?
The people of PICO worked hard to win health coverage for all families – now it’s time to deliver the fruits
of our labor! We are in unique position to do this – congregational teams are trusted messengers and can
be a powerful force for outreach. Historically, working class populations and communities of color have
been denied healthcare access, received prejudicial healthcare treatment or lacked culturally competent
care. The Affordable Care Act is an opportunity to drastically impact those racial and ethnic disparities.
We as a faith community have an opportunity to build accessibility for the first time for those who have
never had it and facilitate positive relationships between our communities and healthcare facilities as we
mediate the enrollment process.
Overall about 25 million people will be newly eligible for healthcare that weren’t originally. That number
has decreased since the ACA was originally passed due to the number of states that rejected Medicaid
expansion. Meanwhile, 78% of those eligible for tax credit premium subsidies are unaware of it and 83%
of those eligible for Medicaid expansion are also unaware. Unless we educate, outreach and empower,
we miss an opportunity to provide much-needed health care to our congregants – the very people that
helped pass health reform.
PICO’s Role
The PICO National Network worked tirelessly to shape the 2010 Affordable Care Act to meet the needs
PICO National Network ▪ Unlocking the Power of
People www.piconetwork.org
171 Santa Rosa Avenue ▪ Oakland, CA 94610
Phone: 510 655 2801 ▪ Fax: 510 655 4816
4
of working families. PICO played an important role in framing affordability for lower-income families as a
central issue in the health reform debate that ultimately led to the passage of the Affordable Care Act.
PICO convened and staffed a national religious roundtable on health reform that encompasses religious
denominations representing approximately one-third of the nation. We shaped the policy agenda of a
number of national denominations.
PICO and Faith in Public Life were the two lead organizations that organized and produced the August 19
national conference call with President Obama (144,000 participants) [speakers on the call included eight
PICO clergy and grassroots leaders]; and our organizations worked closely to build a powerful organizing
and media campaign on health reform that has generated hundreds of earned media stories, run paid
radio and TV ads on health reform, placed paid organizers in key states (CO, NE, ND, AR, PA and ME),
organized hundreds of local events and collected hundreds of stories in support of reform. The synergy
from sophisticated media strategy and good grassroots organizing in key states led to the passage of the
Affordable Care Act.
We fought for healthcare for all. Now is the time to bring the benefits of health care home.
Affordable Care Act Basics
The Affordable Care Act is an
incredibly large and complex piece of
PICO National Network ▪ Unlocking the Power of
People www.piconetwork.org
171 Santa Rosa Avenue ▪ Oakland, CA 94610
Phone: 510 655 2801 ▪ Fax: 510 655 4816
5
legislation that includes many facets that do not include the new healthcare exchanges that begin in
October. For the purposes of this toolkit, we’ll outline the very basics for you.
Different iterations per state:
Exchanges are competitive marketplaces for individuals and small businesses to purchase insurance.
Insurance can be purchased through the exchange on online web-portal, in-person, by phone or by mail.
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State-Based Marketplace
State-Partnership Marketplace
Federal Marketplace
Medicaid Expansion:
For those with low incomes,
Medicaid has been expanded now
to 138% of the federal poverty
line. In June 2012, the supreme
court decided to uphold the
constitutionality of the Affordable
Care Act but chose to make
Medicaid expansion optional per
state. Though many could not
predict the number of states that
would turn down an opportunity
for free money from the federal
government and a chance to
drastically improve public health
in their states by providing
healthcare to millions, 14 states
have rejected Medicaid expansion
and 9 are still undecided or are pursuing an alternative model.
Tax Credit Premium subsidies:
For those with incomes above poverty, health insurance can be purchased through new marketplaces,
and those with incomes below 400% of the federal poverty line will receive large tax credit premiums
subsidies. These subsidies are provided on a sliding scale so lower-income people get larger subsidies.
 Income Eligibility for Tax-Credit Premium Subsidies
o Household of 1: $45,960
o Household of 2: $62,040
o Household of 3: $78,120
PICO National Network ▪ Unlocking the Power of
People www.piconetwork.org
171 Santa Rosa Avenue ▪ Oakland, CA 94610
Phone: 510 655 2801 ▪ Fax: 510 655 4816
6
o
Household of 4: $94,200
Who are enrollment partners? What are navigators?
There are different types of enrollment partners that we will work with. To be legally allowed to enroll, an
organization must recruit and train Navigators or Certified Application Counselors (CAC). Both are
people trained to help people “navigate” the exchange and weigh out their health plan options.
Navigators and CAC’s can be hired through local health facilities and non-profits such as SEIU, Kaiser,
Enroll America or other local community groups.
The Mandate
Unless you have a circumstance that exempts you from buying insurance (i.e. undocumented, formerly
incarcerated, member of an Indian tribe, etc.) or you were already ensured for the whole year through an
employer, Medicaid, Medicare, etc. you will receive a penalty for being without insurance.
The individual responsibility requirement does not apply to some:
 people who cannot afford coverage (defined as those who would pay more than 8 percent of
their household income for their premiums)
 undocumented immigrants
 people without insurance for less than three months
 individuals with incomes below the tax filing threshold.
Funding
There are potentially multiple funding streams for our PICO federations to participate in enrollment work.
Funding varies greatly from state to state so you’ll need to do some research to find out what options are
PICO National Network ▪ Unlocking the Power of
People www.piconetwork.org
171 Santa Rosa Avenue ▪ Oakland, CA 94610
Phone: 510 655 2801 ▪ Fax: 510 655 4816
7
available to you.
For Federal Marketplace States: Health and Human Services will give out grants to enrollment partners in
your state. There is a chance you could attempt to sub-contract that money out through these partners
to assist in enrollment. For State-Based Marketplace States: Often the exchange in your state will
provide funding to help with enrollment efforts. Allied community groups and foundations will also
provide funding such as Enroll America, SEIU and others.
Case Study: California Model
California was able to start enrolling community members through the Affordable Care Act beginning in
March, 2012. The San Diego Organizing Project hosted a small scale operation in enrollment.
What they did:
1. Hosted direct enrollment events in partnership with local clinics within their 4 larger Latino
churches.
 Enrollment partners brought laptops, scanners, etc. and enrolled people on the spot.
 Organized significantly by SDOP leaders - teams of 5 leaders in each church.
 Started recruitment 2-3 weeks ahead of time through bulletin announcements, education at
the pulpit and flyers.
2. Made announcements in their smaller churches and handed our flyers and sign ups sheets to
enrollment partners to contact. Educational, you will be followed up with.
3. Funneled community members from enrollment events into an organizing campaign on the
county to take down structural enrollment barriers.
What worked:
• Built a list of 1,200 uninsured or newly insured congregants.
• During the 2012 elections they canvassed this same list with the message: “you just
received healthcare for the first time in your life and you could lose it unless we vote for
PICO National Network ▪ Unlocking the Power of
People www.piconetwork.org
171 Santa Rosa Avenue ▪ Oakland, CA 94610
Phone: 510 655 2801 ▪ Fax: 510 655 4816
8
•
•
•
•
•
•
people that will support it.”
Enrolled many people
Had a captive audience at the enrollment events: registered voters, surveyed people around
issues, did mini one to ones – an easy listening campaign.
Engaged 25 leaders and channeled 200 people from enrollment efforts into a direct action on
the county.
Built a motivating narrative around racial inequity in healthcare for their leaders
Asked enrollment partners to commit to enrollment one Sunday a month for 4 months – one
church at a time.
Used education at the pulpit and detailed flyers to:
• Screen people based on eligibility
• Remind people to bring proper documentation to the enrollment event (proof of
income, residency, drivers license, etc.)
Challenges:
• Couldn’t publicly branding anything as “Affordable Care Act” within their Catholic churches
• Many structural barriers to actual enrollment: (i.e. misinformation by the county, data collection
troubles)
• Long lines: pre-screening events could have been quicker, more efficient
• Many people did not bring proper documentation to enrollment events and had to schedule
follow up appointments
• Scheduled enrollment appointments had high no-show rate
Why is enrollment in our self-interest?
Leadership development
Enrollment and outreach could be run almost entirely by your leaders. Outreach takes place in our
PICO National Network ▪ Unlocking the Power of
People www.piconetwork.org
171 Santa Rosa Avenue ▪ Oakland, CA 94610
Phone: 510 655 2801 ▪ Fax: 510 655 4816
9
churches where our leaders reside and can be a powerful opportunity for them to bring in new faces and
build relationships with congregants in a way that inherently illustrates part of that person’s story: they
need healthcare.
Build lists for civic engagement work
People are eager to sign up when they see the potential to receive free or cheap healthcare. Whether it’s
just a sign up sheet in the fellowship hall and a couple announcements during church service or a largescale enrollment fair, people are eager to sign up. We can use these lists in during elections cycles to
identify healthcare
Provides a platform to channel people into organizing campaigns
Whether you bring people into an organizing campaign around Medicaid expansion, healthcare
enrollment policy improvements or a campaign unrelated to healthcare, enrollment events provide a
platform for us to organize and build power.
Empower our community
How often do we pass federal or
state legislation that benefits our
people but never gets used or
known about? What good is our
work to pass legislation if no one
ever benefits from it? We worked
hard to pass the health reform.
Lets make sure our people are
empowered to make smart
choices for them and their
families and get healthcare!
Register Voters
Enrollment work is an easy way
to register voters on the spot.
They’ve already come with the
proper documentation – proof of residency, drivers license, etc: sign them up to vote while they’re at it!
Keep in mind that while only a fraction of the people we engage will actually get enrolled in healthcare –
ALL people we engage can get registered.
Position Ourselves as Leaders within the Healthcare Community
To do this work requires building relationships with local and state level health facilities. We become a
bridge, an entry-way or a mediator between people and their first experience of healthcare.
PICO National Network ▪ Unlocking the Power of
People www.piconetwork.org
171 Santa Rosa Avenue ▪ Oakland, CA 94610
Phone: 510 655 2801 ▪ Fax: 510 655 4816
10
ENROLLMENT PROCESS CHECKLIST
STEP 1: Research
 What type of exchange is in your state?
 Has your state chosen to expand Medicaid?
 Where are high geographies of uninsured people? What congregations are likely to contain the
most eligible people?
 Who are strong enrollment partners in your area? Which clinics, hospitals or allied groups could
you partner with for enrollment outreach?
 Do your enrollment partners, Health and Human Services, your state exchange have funding
you can access? If so, what is the conditionality? When is the application due?
 What is your capacity? Which leaders have excitement around this?
STEP 2: Establish
 Meet with PICO staff and determine the level of engagement which your federation will
participate in the enrollment campaign.
 Create a organizing plan for enrollment:
o Target state policy shift goals
o Target number of people engaged and enrolled
o Leadership development and relational goals
 If available, apply for funding through local foundations, your state or non-profits.
 Establish relationship with enrollment partners and coordinate enrollment outreach efforts
together. Can they provide:
o Training for your staff?
o Funding to assist outreach?
o Materials?
o Database? Lists we can contact?
o Staff time to send navigators to enrollment events?
 Work with enrollment partners and PICO to train in federation staff, congregational staff and
leaders on the ACA and enrollment options for their state/county.
STEP 3: Planning
 Start making plans with your congregations for outreach events.
o Identify leaders and staff to plan outreach
 Work with enrollment partners to modify materials to suit your federation/state community.
o Logistics: what programs are folks enrolling for?
o Messaging: What language will best suit your area?
 Determine how you will collect data. What information will be tracking?
STEP 4: Execute!!!
PICO National Network ▪ Unlocking the Power of
People www.piconetwork.org
171 Santa Rosa Avenue ▪ Oakland, CA 94610
Phone: 510 655 2801 ▪ Fax: 510 655 4816
11
LEVELS OF ENGAGEMENT
Enrollment work can take place in multiple forms with varying levels of effort. Enrollment could be as
little as making an announcement during church, handing out a flyer and having folks sign up on a sheet
in the back of the church after the service is over that you can hand off to enrollment partners to contact.
It could also be as much as doing canvassing door-to-door efforts, hosting multiple large enrollment fairs,
asking congregants to talk to people they know about spreading the word, etc.
1.
Minimal engagement:
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2.
Know who key enrollment partners are in your state.
Write email blast out to your membership list that educates on ACA, promotes
enrollment events sponsored by enrollment partners and refers to enrollment partners
sites
Include info blurb in bulletins
Make announcements about enrollment during church services and host a sign up sheet
in the back of the church or fellowship hall which can be passed off to enrollment
partners for contact in targeted churches
Maximum engagement:
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Identify key enrollment partners your federation can collaborate with
Write email blast out to your membership list that educates on ACA, promotes
enrollment events sponsored by enrollment partners and refers to enrollment partners
sites
Send out ground-mail blast that educates on ACA, promotes enrollment events
sponsored by enrollment partners and refers to enrollment partners sites
Include info blurb in bulletins
Make announcements about enrollment during church services and host a sign up sheet
in the back of the church or fellowship hall which can be passed off to enrollment
partners for contact in targeted churches
Host “pre-screening” events after church services with voter registration
Partner with allied organizations to host large community-wide enrollment fairs with
voter registration
Host canvasses in targeted areas that educate, pre-screen and/or schedule
appointments with actual enrollment partners.
PICO National Network ▪ Unlocking the Power of
People www.piconetwork.org
171 Santa Rosa Avenue ▪ Oakland, CA 94610
Phone: 510 655 2801 ▪ Fax: 510 655 4816
12
Timeline
June
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Face to Face training of organizers at Applegate /sample toolkit
Federations assisted with developing relationships with Enrollment Partners
Federations set timeline and organizing plan
July
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Congregational Toolkit released downloadable to our website at www.piconetwork.org
Federations begin congregation recruitment
Enrollment webinar
August
 Federations continue recruiting congregations
 Kick-off congregational trainings for all Federations
September
 Outreach event planning begins
October
 Launch outreach efforts!
o Congregational bulletin materials, signage, fliers
o Adult forums
o Enrollment Summits
o Neighborhood canvasses
References
We want to give credit to Community Catalyst, the Kaiser Foundation and Families USA for providing the
information used in this document. PICO takes full responsibility for the content.
PICO National Network ▪ Unlocking the Power of
People www.piconetwork.org
171 Santa Rosa Avenue ▪ Oakland, CA 94610
Phone: 510 655 2801 ▪ Fax: 510 655 4816