Jesse Grant, the outreach enrollment case manager at Hartford’s Charter Oak Health Center, says the people he talks to about health insurance come out happy. “I get hugs,” he said.

In their quest to help people sign up for insurance offered under the federal health law, the staff at Charter Oak Health Center have talked to more than 3,000 people. But a few stand out, like the man who was so happy to have insurance — for $49 a month — he was shouting on the way out. Or the young man with bad eyes who couldn’t afford glasses but would, as of Jan. 1, qualify for Medicaid.

“He can get those much-needed glasses, and he was so freaking happy,” said Jesse Grant, the health center’s outreach enrollment case manager and self-appointed promoter of Obamacare to just about anyone who will listen.

Charter Oak sits two blocks from the gold-domed state Capitol in one of the most uninsured pockets of Connecticut.

Forty percent of Connecticut’s estimated 310,000 uninsured residents live in 20 ZIP codes, according to the most recent census estimates. Close to half of the uninsured are concentrated in 30 ZIP codes.

At the heart of the federal health law commonly known as Obamacare is the aim of getting the uninsured covered. And that’s where people like Grant and his colleagues come in. They’re among more than 300 people tasked with reaching out to the uninsured and helping them sign up for coverage. Many work in areas like Hartford, where as many as one in four residents lack health insurance.

They’ve signed up school bus drivers, community college students and adjunct professors, people who wait tables and work in nail salons, people who speak little or no English, and those with pre-existing conditions.

But they’ve also had people leave their appointments seemingly no further to coverage than when they started, worried that even heavily discounted insurance will cost too much or discouraged by the options.

The working uninsured

Eva Bermudez clicked through application screens on her laptop, taking information from the woman next to her and occasionally pausing to tap numbers into her iPhone calculator. It was close to noon on a rainy Friday, and Bermudez had been working the computer for hours inside the small building on the grounds of the Dattco bus yard on north Main Street in Hartford.

An organizer for the union CSEA SEIU Local 2001, Bermudez is one of close to 300 “in-person assisters” trained in the details of Obamacare to help people sign up for coverage.

Eva Bermudez, an in-person assister charged with helping people sign up for coverage as part of the federal health law, works on an application at the Dattco bus yard in Hartford.

She helped Marie Borange and her husband, Louines Louis, sign up for a plan through Access Health CT, the state’s health insurance exchange. With federal financial assistance factored in, they’ll pay $90 a month.

Borange, 60, works as a school bus monitor for a company that doesn’t offer coverage. She has diabetes and acid reflux and relies on Walmart for cheap prescriptions. Dattco, where her husband works, offers coverage, but they can’t afford it.

So the Hartford couple pays for medical care themselves. They’re still paying off the bills from two surgeries he had last summer, at $100 to $150 per month.

“I talk to God every day,” Borange said.

What she wants most is dental care, she said, opening her mouth to show her crooked teeth. But that’s a service not covered by the plans sold on the exchange. She’d have to buy a separate, stand-alone dental plan for that.

Marie Borange and Louines Louis are still paying off the bill from two surgeries he had last summer. They signed up for a health plan that will cost $90 per month.

Because of the way Connecticut has rolled out the provisions of the Affordable Care Act, many of the state’s uninsured are, like Borange and Louis, working. The state became the first in the nation to broaden its Medicaid program after the health law passed in 2010, meaning that the very poorest Connecticut residents already have access to coverage. The working poor often don’t.

The union Bermudez works for represents state employees, whose health insurance is the envy of many in the private sector. But it also represents paraprofessionals, day care providers and school bus drivers, many of whom aren’t offered insurance or can’t afford their employers’ plans.

By the end of 2013, employees of Bermudez’s union had signed up 702 people. She was responsible for 462 of them.

Unlike the federal website used by exchanges in 36 states, which faced highly publicized problems, Access Health’s site has functioned relatively well. But like many assisters, Bermudez noted that doesn’t mean it’s been problem-free.

Some assisters complained about the system sometimes failing to verify applicant’s identities. Sometimes it showed applicants prices without including the steep discounts they’d receive to help pay for insurance. Grant, outreach enrollment case manager at Charter Oak, was helping one guy apply when he got a message from the system saying the man, who was sitting in front of him, was incarcerated.

Because eligibility for Medicaid and discounted insurance is based on 2014 income, Bermudez faced a different challenge: Trying to figure out what people who work irregular hours would likely earn in a year. School bus drivers, in particular, don’t fit an easy template. Sometimes they pick up additional runs during a week. They don’t necessarily keep the same routes from year to year. And during school vacations, they receive unemployment.

After a few weeks, Bermudez developed her own formula for estimating their incomes, which she calculated using her iPhone. She whipped through the calculations as she helped another driver, Lilia Rosa, apply for coverage that the New Britain woman indicated couldn’t come soon enough.

Despite medical problems, Rosa once went two years without seeing a doctor because she had no insurance. Then, after an accident last summer, she wasn’t able to work and qualified for HUSKY, the state’s Medicaid program. With coverage, she got up to date on her medical care. But when it came time to renew her HUSKY coverage, her income was too high, and she was put on a spend-down. That meant she could get Medicaid if, within one six-month period, she spent $8,000 out-of-pocket on medical care.

Lilia Rosa learned she qualified for Medicaid but she’s thinking about moving to a state where she might not have that option.

As Bermudez clicked through the application screens, Rosa let spill a potentially pertinent detail: She wants to move to Texas in the coming months. I can’t take this state anymore, Rosa said.

Bermudez stopped. “You’re going to have insurance for like two months,” she said, skeptically.

“I still need it,” Rosa said, shaking her head with resignation.

“Fair enough. You’re doing the right thing,” Bermudez said, returning to the computer.

A few more screens, a few more questions and a warning from Bermudez that lying to an assister is fraud “and they will find you,” and they got the verdict: Rosa’s two children would qualify for Medicaid. She would, too. Come Jan. 1, you’ll have full insurance with no expenses, Bermudez said. “And you don’t have to pay a cent.”

Rosa, who grew up in Hartford, said it’s hard to live in Connecticut, especially with the car and home taxes. Texas seemed like an appealing comparison.

But Ben Phillips, the union’s communications director, pointed to a downside: Texas isn’t expanding its Medicaid program. Rosa might end up uninsured there, too, even under Obamacare.

Language barriers

A notice about getting health insurance in Vietnamese at the Connecticut Coalition of Mutual Assistance Association’s Hartford office.Chi Hoang was taking appointments at his unofficial Sunday office on the first floor of a house just off Park Street in Hartford’s Parkville neighborhood. It’s the headquarters of the Connecticut Coalition of Mutual Assistance Associations, which serves refugees from around the world. One wall held a map of the United States. On the wall across from it were signs about health insurance in three languages.

One man came to drop off a document needed to verify information in his application. Because his English is limited, Hoang would call the Access Health call center with the man the next day, sitting next to him and interpreting.

Hoang initially demurred when the coalition asked him to become an assister, wary of the time commitment. A tax accountant who lives in Glastonbury, he’d recently retired after three decades at Northeast Utilities. He’d also spent years preparing tax returns on the side, making him well-known in the Vietnamese community.

He came around to helping people enroll after deciding it would be a good chance to help the community. Many Vietnamese immigrants are self-employed and haven’t been able to afford to buy insurance on their own, or work low-wage jobs that don’t provide coverage, he said.

Chi Hoang, a retired tax accountant, helps people apply for coverage and often serves as a translator for people who speak limited English.

More than a third of Connecticut’s uninsured are poor enough to qualify for Medicaid, according to a recent analysis by the Kaiser Family Foundation. And a quarter have moderate incomes that will qualify them for federal financial assistance to buy insurance.

The rest aren’t eligible for the new free or discounted insurance options, either because their incomes are too high or they get coverage through their jobs (25 percent of the uninsured) or because they’re not in the country legally.

Some of the uninsured were eligible for HUSKY before the program expanded Jan. 1, but weren’t enrolled.

That includes some of the people Hoang helped sign up.

“I don’t understand it,” he said, shaking his head. “I don’t know why they never applied for Medicaid.”

Some of those he signed up work in restaurants as cooks or waiters. Some work in nail salons. Some are older and live with their adult children and haven’t worked in the United States.

Many speak limited English and had heard about Obamacare, but didn’t know much about it, he said.

One good thing about Obamacare, Hoang said, is that it makes news, and people learn they might have new options. The agency has tried to reach the area’s Southeast Asian communities, advertising in grocery stores and restaurants.

And because there’s no other material available about the health law in Vietnamese, part of Hoang’s role is as a translator.

One challenge, Hoang said, is making it clear to clients who qualify for discounted insurance plans that the exact amount of financial aid they’ll get will depend on their 2014 income, so the price they’re quoted could be higher or lower than what they ultimately owe. He tries to make his clients aware. “I don’t think the average person understands that,” he said.

Where the underserved go

Like the state’s other community health centers, Charter Oak has several people on staff trained to help enroll people in coverage. The health center hosts enrollment fairs, but often, staff don’t have to look far to find the uninsured. Among the health center’s patients, 21 percent are uninsured.

“What you have to realize is that Charter Oak…this is like the house for the underserved,” said Ann Patterson, the health center’s chief of quality assurance.

Among those who have looked at their new coverage options, the results have been mixed.

Zuleika Cruz, a Charter Oak outreach and enrollment case manager who’s certified to help people with applications, said many people have been surprised at the cost, thinking discounted insurance should be cheaper. “It’s not what the news is saying, it’s not what they’ve been hearing. So they’re in shock,” she said.

They list their other expenses, like rent, and tell her it will be hard to pay. But after the initial surprise, some say they’ll think about their options and come back.

Grant claims a higher success rate. “Ninety-nine percent of those folks who walk out my door are very happy,” he said. “I get hugs.”

There’s the woman who was paying $406 per week for employer-sponsored insurance for her family of five. An exchange plan would save her family more than $1,400 a month, he said.

Grant is eager to tell people about the health law and the history of similar health reform efforts. If he sees a large group of people in the lobby, “it’s on,” he said — he’ll do an impromptu presentation on health reform. He’ll also tell you about the problems of the pundits in Washington who comment on the rollout of the law, the cable TV talking heads spewing what he calls “propaganda.”

Not everyone who wants to sign up can.

Carmen Sarmiento, an outreach worker and exchange application counselor at Charter Oak, said many people who aren’t in the country legally have come in, thinking they must sign up for health care under the law. In fact, they’re exempt from the law’s coverage mandate, and ineligible for the new coverage options the law provides.

And so, a colleague lets them know: We’ll still see the uninsured.

CT Mirror Data Editor Alvin Chang contributed to this story.

Arielle Levin Becker covered health care for The Connecticut Mirror. She previously worked for The Hartford Courant, most recently as its health reporter, and has also covered small towns, courts and education in Connecticut and New Jersey. She was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on caregivers from the National Association of Health Journalists. She is a 2004 graduate of Yale University.

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