Outreach workers in rural areas face obstacles as they help citizens explore insurance options and enroll in plans available under the Affordable Care Act, the Associated Press reported.
In Florida, Michigan and Idaho--large states with high concentrations of uninsured residents--advocates are challenged by healthcare accessibility issues, including provider shortages, residents' lack of transportation to medical facilities, lack of internet and cable connectivity, and attitudinal barriers about reform, according to another AP article. Parts of the Florida panhandle, for example, have few local practicing physicians, and some of that already-small group don't participate with all insurers.
These issues highlight larger problems meeting President Barack Obama's goal of decreasing the population of uninsured Americans through Medicaid expansion and the new marketplaces created by the reform law, the AP noted.
Many low-income Americans who qualify for subsidized coverage won't buy it for three reasons: the tax penalty's cheaper than a monthly premium, they don't support the ACA or they worry about the security of their personal information entered into government databases, the AP noted.
Sue Cook, an advocate who leads a team of volunteers in large counties of northeast Michigan, reported "huge hurdles" in enrollment efforts despite the occasional anecdotal success story.
Christopher Mitchell, an outreach worker for PanCare of Florida, told the AP it's hard to influence people when they're convinced the ACA "is bankrupting America." Further, some people told Mitchell that even with federal subsidies they still wouldn't have enough monthly income to pay for utilities, food, gasoline and health insurance premiums. And since Florida opted out of Medicaid expansion, many residents who would qualify for Medicaid under federal guidelines do not qualify under the state's guidelines, the AP reported. While citizens can appeal Medicaid eligibility determinations and seek help lowering their premiums, those appeals aren't always successful.