Californians who are sick are expected to quickly sign up for subsidized private insurance through the state exchange. But to keep premiums down, the state also needs large numbers of healthy people to sign up.
"It is vital to the success of the exchange that we have mass enrollment on Day One," said Anthony Wright, executive director of the consumer group Health Access California.
On the Medi-Cal side, the federal government will cover the entire cost of care for newly eligible enrollees for the first three years, starting Jan. 1, 2014. That means the state will lose money for any patient it treats who could have been covered.
California got a head start on expanding Medi-Cal coverage by signing up more than 550,000 low-income people in a temporary program. Those patients are expected to automatically transition into Medi-Cal in 2014.
Antonia Santana, a self-employed housekeeper, is covered by the interim program, Healthy Way L.A. Santana, 50, said she has high blood pressure and relies on the coverage for her medication and doctors' visits. She hopes to receive Medi-Cal coverage when the healthcare overhaul takes effect. "I won't have to be thinking, 'If I get sick, where am I going to go? How am I going to pay for that?' " she said.
In addition to marketing, state health officials are investing millions of dollars in a website and enrollment system intended to present consumers their options and costs.
However, up to 75% of applicants are expected to need face-to-face help navigating the enrollment process. They could include poor families, middle-income working residents, homeless people and small-business owners. That will mean that an estimated 25,000 paid and unpaid representatives speaking as many as 13 languages will need to be recruited, trained and dispatched.
"The state has to figure out how to reach all of these groups, and they all require a different strategy," said Larry Levitt, senior vice president of the Kaiser Family Foundation. "Boring federal government public service announcements airing at 2 in the morning are not going to work."
Community, religious and health advocacy organizations are expected to play a critical role. Chu of OneLA said the best outreach strategy is inviting people to sit down with someone they trust. "This isn't a model of let's build it and they will come," he said. "They have got to go to where the customers are."
For patients who fall though the cracks or get tangled up in the new bureaucracy, organizations like the Pacoima-based Neighborhood Legal Services hope to help. The group is already dealing with billing problems and lack of access to care in Healthy Way L.A. As the healthcare overhaul ramps up, the group's hotline is likely to get many more calls.
"It's going to be a very bumpy road," said Cori Racela, a staff attorney. "And things are not that smooth already."