Volunteers in New Jersey distribute information about the health insurance options offered through the Affordable Care Act.Michael Nagle/Bloomberg/Getty Images
NEWARK, N.J. — Wale Ogundipe and Carlos Vasquez looked a little apprehensive as they walked into Hector Perez’s front yard.
Perez was leaning into the window of a black SUV, chatting with a friend. Shirtless, with tattoos splayed across his muscular arms and chest, he cut an intimidating figure on his lawn, particularly to two young, out-of-town volunteers charged with discussing health care options with strangers.
Ogundipe, 29, whose day job is in marketing, tentatively started, extending a hand and saying, "Hi, sir. My name is Wale, and this is Carlos. We're here with Enroll America, specifically the Get Covered campaign.”
Ogundipe and Vasquez, 18, explained it is a nonprofit organization and they were there to discuss a provision of the Affordable Care Act, the state-level online marketplaces that will open Oct. 1 and allow consumers to shop for coverage plans and apply for federal subsidies to help them purchase insurance until Dec. 31.
"Right now, health care in this country is changing so that some people are going to be eligible for additional benefits because of the legislation, so we're just volunteers letting people know,' Ogundipe said.
Organizers of this particular canvass had warned volunteers when they met that morning in a McDonald's parking lot that they might encounter hostility among some, especially on an issue as politically divisive as the new health care law.
But despite appearances, Perez wasn't the least bit antagonistic. He was curious. He would be losing his health insurance when his divorce was finalized in a few months, he said, but was living with a woman who had health insurance.
"How would that affect me if I go to apply?" Perez asked.
The volunteers, far from policy experts, didn't know and had been told that it was better to tell people the truth rather than spread more misinformation about the law -- already a rampant problem. Ogundipe directed him to go to healthcare.gov or visit a free clinic in the neighborhood where there would be federally certified "navigators" starting Oct. 1 to explain the specifics.
"I just heard that there's one going into effect, but I couldn't tell you anything about it," Perez said about the law.
He is, nevertheless, well aware of how important health care is for him and his family, he said. A bad car accident left him in need of a few surgeries last year and even with health insurance, the expenses piled up.
"Even with health coverage, it's pretty difficult, and I couldn't imagine not having it," he said. "I worry about it, especially for my children. It's crazy where we are, being one of the superpowers in the world and ranked so low in health care. It's really a shame, and we can do a better job."
Therein lies the problem of educating Americans about the ACA. The subject is deeply personal and central to people's lives but frustratingly dense. That doesn't lend make for easy explanations on doorsteps.
The exchanges that Vasquez and Ogundipe were telling New Jersey residents about are among the centerpieces of the ACA, meant to help the 44 million uninsured in the country find affordable coverage. The law's success is contingent on enough healthy people signing up for the exchanges to offset the higher health costs of those with existing conditions and keep premiums in the entire system from skyrocketing.
But efforts have been under way in several states to discourage people from signing up for them; Congress has repeatedly denied additional funding to help the Obama administration with implementation; 33 states have refused to set up exchanges, leaving the task up to the Department of Health and Human Services; House Republicans recently embarked on yet another effort to defund the law; and the GOP has stepped up its investigation of the navigators, saying the program is rife with fraud.
"You have different stories in parts of the country," said John Holahan, a health policy expert at the Urban Institute, a center-left Washington think tank. "Some states have been out there in the beginning and have a pretty good enrollment experience for people … and then you have states that are completely hostile to health reform, and the federal government is going to set up their exchanges. That's going to be confusing to people."
It's in this environment that volunteers with Enroll America, run by a former Obama administration official, and other community organizations are trying to do the work the government cannot. They've spent weekends fanning out across neighborhoods, particularly low-income and minority communities where there's a high likelihood of finding uninsured people, to run a shoestring educational campaign.
As Ogundipe and Vasquez knocked on dozens of doors across a few city blocks, they got everything from blank stares to keen interest to entreaties to come back another time because people were busy.
"Can we ask this? Regular time or Hispanic time? Because five to 10 minutes in Hispanic time is an hour," said one woman at her doorstep, in her nightgown, who said she had to get back to her cooking.
Her son, 28-year-old Jorge Ramos, was more interested. He played men's rugby for a small college in New Jersey and had recently lost his student health insurance.
"If something bad happens, I'm pretty much screwed," he said, raising a hypothetical sports-related injury. "(If) I have a broken toe, then I just have a broken toe, and that's not good. And I can't play with a broken toe."
Had he heard about the health care law?
"Nothing," he said. "I haven't heard zilch about the new law. Is there a new law for health insurance?"
The Newark residents have plenty of company. A USA Today/Pew Research Center poll shows the obstruction efforts are working: only 51 percent of Americans know about the existence of health care exchanges in their state. The same percentage know that low-income residents could be eligible for subsidies.
Many of the people Ogundipe and Vasquez talked to had traumatizing experiences with the health care system in the United States.
Jessie Almonte, 19, knew nothing about the ACA either and had plenty of bills to pay from the last time she was in the hospital, for the birth of her now 9-month-old son, even though she was insured under her mother's plan.
"Is this going to help with that?" she asked.
Jacob Reviriego, 30, was similarly consumed by the bills after his mother went to the hospital in June after suffering chest pains.
"We were getting bills from the hospital, we were getting bills from the cardiologists, and we're getting the bills from the doctor, bills from everywhere, and I have to call her insurance company to figure out all these different claims, and what am I supposed to pay out of pocket?" he said. "What are you supposed to do?"
Reviriego is temporarily without health insurance but hopes to get covered when he starts a job as a pharmacist in the next few months.
"This is all a little bit overwhelming, and they should really give more information," he said, studying the pamphlets. "There's really not enough information that the lay citizen needs. Because you have the big shots up there making all the decisions, but when it trickles down to the ordinary person, we really don't know what's going on."
The frustration is palpable as average Americans look for answers their questions about the new law and continue hoping for something generally more accessible and understandable.
One man who didn't have time to talk while sitting in an idling car in his driveway shouted through a window, "Tell somebody that we have the worst health care system in the world!"