As an organizer for Enroll America, Sean Murphy's job is to spread the word about the Affordable Care Act. But for someone whose job is related to health care, he hasn't been eating very healthy.
"I've had so much pizza since I started this job," says Murphy, a regional organizer for the nonprofit. But the pizza is more than a dietary choice. On this afternoon in the lounge at the Community College of Allegheny County's South Campus, it's bait to lure students to his table to talk about their health-care coverage or the lack thereof.
And it works. Fifteen boxes of pizza all but disappear in less than 20 minutes, but it also attracts students with questions and concerns.
At the event, Murphy and three navigators from local nonprofits addressed questions that ranged from "Am I already covered?" to "How much does it cost?" Navigator is the official title of workers who get certified to walk people through the various insurance plans available on the ACA marketplace on the federal government's enrollment site.
"If you don't get a plan, you get penalized. That's the reason I'm doing it," says Tiffany Bernatowicz of Turtle Creek. She stopped by specifically for the event.
A navigator helped Bernatowicz research insurance plans, but she couldn't find even one in her price range —$100 or less. Bernatowicz also learned that she didn't qualify for tax credits to offset the cost.
"Unfortunately, I don't have the greatest income right now, but I've got to figure something out in the next two weeks," she says, referring to the Feb. 15 deadline for what the government calls open enrollment.
Murphy promises to follow up with her.
That earnest demeanor is necessary for those trying to communicate and guide millions of people through bureaucracy, paperwork and new tax provisions associated with the ACA. Enroll America — with its grassroots Get Covered campaign — acts as a referral agency, bringing a team of federally-funded health-care navigators from local nonprofits to its outreach events. With laptops and secure Wi-Fi hook-ups, they travel into communities to find the uninsured.
"If people sit down with an in-person assister, they're about twice as likely to get covered compared to someone who just goes to healthcare.gov, so there's a tremendous value," says Julia Cusick, spokesperson for Enroll America's Pennsylvania operations. The nonprofit was founded in 2010 with the sole mission of spreading the word about the ACA, and is mainly funded by charitable organizations and individual donors. It focuses on a dozen states where Americans who lack health care are concentrated.
"When people are armed with the information they need, they're excited to take action," Cusick says. "Many people still don't understand how much financial help is available to help them pay for their plans, but they can't get that information if a trusted source in their community doesn't engage with them and begin the conversation."
For example, she says, 81 percent of Pennsylvanians who enrolled in a Marketplace plan last year received tax credits.
"We bring consumers to the doorstep of enrollment," she says. "Our partners have deep roots in the communities we serve, and working together allows us all to better reach the Pittsburgh community."
A $250,000 grant allowed one of Enroll America's partners, the YWCA of Greater Pittsburgh, to train existing staff and hire three full-time navigators to go into Downtown, Homewood and the South Hills and focus on "vulnerable populations, such as women, African Americans and Latinos," says Beth Heeb, chief operations officer of the YWCA.
Other partners include the Consumer Health Coalition, Benefits Data Trust, the Hospital Council of Western Pennsylvania, Pennsylvania Health Access Network and Planned Parenthood of Western Pennsylvania (PPWP), which jointly received one $500,000 navigator grant.
"I think Planned Parenthood is uniquely positioned because people know who we are and trust us," says Kate Dickerson, a navigator for PPWP. "We work with a lot of uninsured patients and people who are on Select Plan or Medicaid."
The network of partners reaches even further when you add the connections these organizations have made with physical locations like CCAC and others, including the Carnegie libraries and the Jefferson Regional Foundation. Enroll America has even held sign-ups at the East Liberty busway stop.
"We really just want to give our students an opportunity to get affordable health care," says Antonio Quarterman, director of student life at CCAC's South Campus. "CCAC serves all students. We don't just serve the traditional student population."
Under the joint grant, the group of five nonprofits committed to reaching 43,000 people and actually enrolling nearly 3,000.
Before the current open-enrollment period began, nearly 148,000 people, or 12 percent of the 1.2 million living in Allegheny County, were uninsured, according to numbers from Enroll America and Civis Analytics.
According to the latest overall numbers from the U.S. Department of Health and Human Services, nearly 71,000 residents in the Pittsburgh Metropolitan Area — which spans nine counties — have enrolled this year. About 38,000 are from Allegheny County.
The Pennsylvania Health Access Network says it's receiving more than 500 calls each week to its helpline, especially regarding HealthyPA, former Gov. Tom Corbett's controversial answer to Medicaid expansion. Its enrollment period opened in December and does not have a deadline.
Under the program, Pennsylvanians whose income is 138 percent of federal poverty limit or lower qualify — meaning a monthly income of $1,342 for a single person or $1,809 for a couple.
The program has caused a "massive amount of confusion," says Erin Ninehouser of Pennsylvania Health Access Network. "A straight-forward expansion in year one would've been the best solution."
Rather than expand Pennsylvania's existing Medicaid program, Gov. Corbett, a vocal opponent of the ACA, added another program, Healthy PA, on top of it. Though it grants coverage to 600,000 Pennsylvanians who weren't eligible under the ACA last year, it also has new conditions. For example, people who qualify must search for work, and if they miss a payment, they are locked out of coverage.
"It's helpful being around other navigators. We can help each other out with troubleshooting, especially right now with Healthy PA questions," Kayla Berkey, a navigator with the Consumer Health Coalition, said in between helping people on weekday evening at the Carnegie Library in Oakland. "We can connect with other assisters to find out what's not working so we can do advocacy to change it."
While campaigning last year, new Gov. Tom Wolf said he would adopt the federal Medicaid expansion. Last week, Kait Gillis, press secretary for Pennsylvania's Department of Human Services, said the Wolf administration is working with the "appropriate parties to review Healthy PA."
But regardless of what plan is ultimately used in Pennsylvania, the goal does not change — to get people on an affordable plan — even as these navigators face opposition. In March, the U.S. Supreme Court is set to hear a case in which the plaintiffs want to take away the tax subsidies in the 37 states that use the federal health exchanges, including Pennsylvania. This could potentially make several of the federal plans unaffordable and threaten the viability of the entire ACA.
Meanwhile, on the state level, some in the insurance industry have criticized the training of federally funded health-insurance navigators, saying they could mislead the public. The Pennsylvania Health Law Project, an organization that helps low-income, elderly and disabled consumers secure health care, says there are no examples of such harm.
PA Senate Bill No. 293 calls for tight regulations on in-person navigators and hefty fines for noncompliance. The bill would create new registration requirements by the Pennsylvania Insurance Department for enrollment assisters and "tightly control" conversations the assisters, or navigators, could have with Pennsylvanians about what insurance products to purchase, according to the Pennsylvania Health Law Project, which opposes these types of laws. A similar bill died last year.
But several people who visited navigators at Enroll America's local events said they wanted to talk to someone because they were confused about what to do.
"I wouldn't know what the heck I was doing [without navigators]," said Courtney Keeton, a student at CCAC's Allegheny Campus. "This is my first time without insurance."
Because of her rheumatoid arthritis, she says, it's important to get the medicine she needs to function every day. She said she initially completed her Healthy PA application with help from the Alma Illery Medical Center in Homewood, but she hasn't heard anything since. Murphy, the Enroll America organizer, paired her with a navigator from the YWCA.
"I didn't know this table was going to be here today," Keeton said. "I stopped by because I just wanted to see what they had to say and if I was [headed] in the right direction."
Murphy and the YWCA navigator assured her that a Healthy PA card should arrive in the mail within 30 days.
And earnestly, Murphy told her that he'd "follow up to make sure everything goes OK."