September 21, 2013|By Andrea K. Walker, The Baltimore Sun
Carol Cain tries to ignore the two lumps in her throat, but some days it's hard because they swell and are tender to the touch.
The 59-year-old, who makes a small income watching her grandchildren, hasn't seen a doctor about the problem because she has no insurance and can't afford to pay. She was on a state health plan for low-income adults for a while, but it only covered primary care.
"Now I doctor myself and hope everything works out," said the tall woman with thick dreadlocks pulled back by a headband.
Cain is just the kind of person being targeted as Maryland prepares for the nationwide health care reforms known as Obamacare — but she also illustrates the challenges of a burgeoning outreach campaign. Some Marylanders have let health problems fester. Others rely on hospital emergency rooms for basic care, an approach that drives up health costs.
Many remain skeptical about the impact of the complex new law or believe that it will be too costly. Outreach workers also have encountered misperceptions about the law, including suggestions that it has been repealed. And some Marylanders have embraced rumors, including claims that home sellers will have to surrender some of their profits to pay for the law.
In Washington, the health care law is still being hotly debated. The Republican-led House of Representatives approved legislation Friday that would strip funding from the law, as part of broader federal spending legislation. But Democrats who control the Senate say that is not an option — creating a stalemate on federal funding overall and raising the possibility of a government shutdown in October.
Most people who get health insurance through their jobs won't see a change under Obamacare. But hundreds of thousands of uninsured will have access to insurance through a state exchange — or pay a penalty if they choose not to buy it. Supporters of the measure say that when everyone gets regular care, it will drive down health costs.
As Oct. 1 nears — the day people can begin enrolling in health plans through the state exchange — an army of educators is hitting festivals, neighborhood association meetings and other community events to reach the estimated 750,000 uninsured in Maryland. In the coming months, libraries will target patrons as they come to check out books, hospitals will tell patients who seek care and churches will preach health reform to their congregations.
Others are treating it like a political campaign, canvassing neighborhoods and stopping people as they walk down the street or wait at a bus stop.
"We can't assume that every person is paying attention and understands what is available," said Vincent DeMarco, president of the Maryland Health Care for All Coalition, an advocacy group. "We have to get the message out there."
Cain was at a festival in the Pennrose Fayette Street Outreach neighborhood in West Baltimore when she was stopped by Lynera Gregory of Health Care Access Maryland Inc., which is helping to promote health reform in the state.
"Do you have insurance?" Gregory asked. "Because health reform is coming and you may be eligible if you're not covered," she continued, thrusting a flier into Cain's hands. Cain learned that she might qualify for free health insurance through Medicaid and finally get to see a doctor about her throat problem.
Outreach workers are discovering that Cain isn't the only one confused about Obamacare. And they're hearing many reasons why health reform isn't on everyone's mind. Some worry more about paying bills. Many don't understand the details of the law or assume they don't qualify for insurance.
The hardest people to reach are those who aren't connected to community groups or social services networks, said Kathleen Westcoat, CEO of HealthCare Access Maryland Inc.
At the West Baltimore festival sponsored by Bon Secours Hospital and two local churches, Annette Wilson, 60, said she planned to stick with her health plan with Priority Partners, which manages government-funded plans for low-income Marylanders. "It's been good for me," she said. "I know how it works."
But she perked up when told by an outreach worker from Baltimore Healthy Start Inc., which promotes the health of babies, that she would probably be moved to Medicaid under the new law and get better coverage. Wilson is among 81,000 enrollees in Maryland Primary Adult Care, a limited program for low-income adults that will get rolled over into Medicaid under reform.
"It's not the best coverage," Wilson later acknowledged about her current insurance, which she said covers only primary care visits.
Then she got skeptical about health care reform.
"It's free?" she asked. "What's the catch?"
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