“I call myself an activist, not an insurance agent,” said Raymond Francois, who hosts a local radio show in Creole when he’s not working as an insurance agent or as director of the New Vision Taxi Drivers Association in Miami-Dade County. “I want people to be able to see a doctor instead of waiting until they’re so sick they have to go to the emergency room.”

Together, Francois and about 40 other agents have signed up 4,000 people for health coverage, he said. They hope to sign up another 1,000 by March 31 when the open enrollment period ends.

“Before the health law, traditional health insurance wasn’t affordable in our community. My agency sold mainly life insurance,” said Jean Derosier, whose Fort Lauderdale-based Fundamental Life and Health Insurance Agency serves as an umbrella for agents in Florida’s Miami-Dade, Broward and Palm Beach counties. “Now we sell more health than life insurance plans.”

People earning $11,500 to $20,000 — like Emithe Dujour of North Miami, a 61-year old security guard with two children covered by Medicaid — typify the agents’ customers. Virtually all qualify for generous tax credits under the health law. And virtually all, like Dujour, choose silver- or gold-level plans that cost little or nothing after tax credits are applied.

“I didn’t have insurance. I got a very cheap plan and I’m very happy with Obamacare,” Dujour said.

The agents began educating themselves about the health law and planning their campaign in 2011, according to Derosier. They printed 50,000 fliers and distributed them twice after the healthcare marketplace opened. They hired people to go door-to-door in the largest Haitian-American neighborhoods. And they made sure they had offices — eight in total — in all of them.

“Good morning everybody,” Francois said, smiling at the clients waiting to apply for health plans at his North Miami Beach office Monday morning. His framed engineering diploma hung on the yellow wall above his desk, though he’s been unable to find a job in his field.

“Raymond is the one you can talk to,” said Celimene Alpazile, 63, a part-time taxi driver from Miami Gardens who had stopped by the office hoping to get health insurance for the first time in his life. “He wears his Obamacare T-shirt at the airport taxi lot so those of us who don’t have time to learn about it can ask questions. The drivers feel good about it because he’s one of us.”

Another Haitian-American reaching out to the South Florida community is Louinel St. Albord, host of radio news talk show Mosaïque, which airs in Creole daily at 5 p.m. on Radio Mega. Since the health care marketplace opened in October, one of his most frequent topics has been Obamacare.

“I’m a registered nurse, so I know the importance of preventive health care,” said St. Albord, who works at Carter Healthcare and moonlights as an insurance agent for Fundamental. With a week still to go, St. Albord said he’s sold 1,000 Obamacare plans.

Haitian community churches were a big part of Fundamental’s marketing effort. “You name the church, we would go to the church,” St. Albord said.

But radio is the most accessible way to reach the Haitian community, said the show host, who used to broadcast a similar program in Port-au-Prince. “In Haiti, if 60 percent of families have a TV; 90 percent have a transistor radio. The appetite for radio probably carries over to Haitian communities in the U.S.,” St. Albord said.

The agents originally had hoped to enroll 10,000 people, half of what they expect to achieve by March 31. “It’s a new program, so there’s still a lot of uncertainty and unknowns,” Derosier said.

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But seven months after receiving a $646,000 federal award to act as a “navigator,” or counselor who walks consumers through the enrollment process, the Washington-based group has reported signing up about 350 people — fewer than other  to cover more of South Florida.

Though enrollment is lagging among Hispanics nationwide and only two weeks remain to sign up for coverage under the health law, NHCOA officials say there are good reasons for their low numbers: misinformation about the health law, and a population that is hard to reach and harder to educate.

“The community that we serve is mostly monolingual. They have very low level of education. They are very afraid to ask questions,” said Maria Eugenia Hernandez-Lane, NHCOA’s vice president.

She said the group isn’t trying to reach “everybody in the Latino community. These are the people who, in any program, they are always left behind. … It’s very hard to reach them. They go to bed hungry because they don’t know how to ask for assistance.”

A review of state records, however, tells a different story: NHCOA was late getting off the ground in South Florida, where its only longtime partner is Abriendo Puertas, a Little Havana nonprofit social services agency.

Other navigators and independent nonprofits working to educate and enroll consumers in Miami-Dade say NHCOA is nowhere to be found, and that the group doesn’t have many counselors or community partners — causing a missed opportunity for the Obama administration, which expected Hispanics to be major beneficiaries of the health law.

NHCOA did not  a single navigator in Florida until Dec. 12, more than two months after open enrollment began Oct. 1, according to the state’s Department of Financial Services.

And even now, the group has licensed just 18 individuals as navigators in Miami-Dade, fewer than another local navigator group, Epilepsy Foundation of Florida, which has licensed 55 navigators throughout the state and dedicates 22 to Miami-Dade despite receiving a slightly smaller federal grant than NHCOA.

Epilepsy Foundation — with a $637,000 grant — licensed its first navigator on Sept. 24.

Hernandez-Lane could not explain why NHCOA — which won an additional $646,000 navigator grant in Dallas — waited until December to license its first counselor with the state, saying only that, “They just had to study, really study hard.”

With an estimated 744,000 Miami-Dade residents lacking health insurance in 2011 — more than any other county in Florida,  — others working to enroll eligible Floridians had higher expectations for the group that received more money than any other navigator in the county and the only one with a mandate to sign up Hispanics.

“I know nothing about them. Do they still have a grant?” asked Karen Egozi, chief executive of the Doral-based Epilepsy Foundation.

Enroll America, a nonprofit working to expand healthcare coverage, opened its Florida headquarters in Miami in July and has since hosted more than 400 events throughout Miami-Dade and partnered with dozens of like-minded groups — but not NHCOA.

“We reached out to every navigator and … organization that we learned about, and worked with every one that wanted to work with us,” said Nick Duran, Enroll’s state director. He added that the first joint event with NHCOA has been scheduled for Saturday.

Another Hispanic outreach group working in Miami-Dade, the Hispanic Access Foundation, said it also has partnered with churches and groups like Enroll America.

Have foundation workers ever encountered NHCOA navigators while in South Florida?

“Never,” said the group’s organizer, Luz Marina Terreros.

And the group is not among four others announced as part of a bilingual education and enrollment drive that targeted Hispanics in Homestead on Saturday, an event that included representation from the National Council of La Raza and the Coalition of Florida Farmworker Organizations.

Hispanics as a group have large numbers of uninsured and a high rate of eligibility for government-assisted coverage. According to a February  issued by the U.S. Department of Health and Human Services, more than 8 million uninsured Hispanics nationwide qualify for Medicaid or financial aid to buy a health plan.

In Florida, about 3.4 million Hispanics qualify for some form of government help getting coverage, according to the report, and almost 1 million Hispanics are uninsured.

In the Miami-Hialeah region — an area highlighted in the report — about 394,000 residents are eligible uninsured Hispanics, accounting for about 37 percent of the statewide total.

With the highest uninsured rate of any ethnic or racial group, Hispanics were expected to be major beneficiaries of the health law.

In recent weeks, the administration has made a strong pitch to reach Hispanics, with the president appearing on Spanish-language TV networks to assure viewers that signing up for healthcare will not lead to the deportation of relatives who are in the country illegally.

Only U.S. citizens and legal residents can benefit from the health law, and Hernandez-Lane said NHCOA navigators are not reaching out to Miami-Dade Hispanics who do not qualify.

She said the group had previously partnered with Abriendo Puertas — Opening Doors, in English — to promote civic engagement and empowerment of Hispanics. Public tax filings show that Abriendo Puertas received $95,000 in grants from NHCOA from 2010 to 2012 for Medicare anti-fraud programs.

“We didn’t just arrive there for the navigators program,” Hernandez-Lane said by telephone. “We have been there.”

Though others working to sign up consumers for coverage have not encountered NHCOA navigators at health fairs, enrollment drives or visits to Miami by Obama administration officials promoting the health law, Hernandez-Lane said the group has counselors on the ground.

“Sometimes we can be invisible to the community,” she said, “but we are visible to the people who need us the most.”

Hernandez-Lane said her group has provided a navigator for a National Institutes of Health study of Hispanics, with a Miami field office led by the University of Miami.

A UM spokeswoman said the National Hispanic Council provides one navigator one day a week to help study participants who are uninsured.

The council also has a local office. On a recent weekday morning, six NHCOA navigators dressed in dark blue polo shirts identifying them as “Navegadores” prepared to open their doors at the office in Little Havana, in a small building behind the headquarters for Abriendo Puertas on Southwest First Street. A sign for Abriendo Puertas hangs over the door.

Four people signed in during the first half-hour, meeting with NHCOA navigators who worked on laptop computers and counseled the consumers in Spanish about their insurance options and eligibility for financial aid.

Alice Gonzalez, navigator program coordinator, said the group had been in the Little Havana office since Oct. 1. NHCOA had no state-licensed navigators at the time. She said workers set up the office and educated consumers while awaiting approval.

Hernandez-Lane said NHCOA is now running full steam in Miami-Dade, making pitches to consumers on Spanish-language radio and participating at community events such as the Calle Ocho street festival last weekend.

“We have had more people calling and making appointments and getting ready to enroll,” Hernandez-Lane said.

The federal government tracks navigators’ progress through weekly phone calls and quarterly financial reports. But the Centers for Medicare and Medicaid Services, the federal agency that administers the navigators program, has refused to disclose enrollment and outreach reports for any of the grantees working in South Florida.

Hernandez-Lane said her group has helped 350 people select plans. She said she did not know how many were referred to Medicaid or how many selected a health plan.

CMS would not verify the numbers provided by any of the navigators, but the Epilepsy Foundation said it helped 498 consumers enroll for coverage in Miami-Dade, including 383 who selected a health plan and 115 who were referred to Medicaid.

And at Jackson Health System, where the Public Health Trust received a $238,000 navigator grant in late October — two months after NHCOA and the Epilepsy Foundation — navigators reported enrolling a total of 366 consumers, some in a subsidized health plan, others in Medicaid, from Dec. 1 to March 1.

And then there are the looser, more general “outreach” numbers cited by navigators. NHCOA says it reached lots of people in person — a total of 4,520. Epilepsy Foundation reports its navigators reached 3,129, and Jackson says they reached 1,280.

But Hernandez-Lane’s numbers mean NHCOA’s 18 navigators would have had to counsel 53 people a day, at a minimum of 45 minutes each, every day, including weekends, from Dec. 12, when its counselors were first licensed in Florida, to March 7, when Hernandez-Lane reported the numbers.

If NHCOA navigators were working at such a furious pace, then their efforts were not visible to other groups also working in South Florida.

“National who?” asked Jason Conner, who manages a team of 10 full-time enrollment counselors at Miami’s Borinquen Medical Centers, a network of federally qualified health clinics that help enroll consumers separately from navigators.

“When it comes to what they do,” said Paul Velez, chief executive of Borinquen, “they’re not a name in healthcare. There’s not even an affiliate here.”

Hernandez-Lane said NHCOA is working to change that perception in South Florida. The group registered as a nonprofit corporation with the state in November, because, she said, “We want to eventually be able to set the roots and get into these communities that need our presence.”

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South Floridians are sifting through information about the most sweeping social program to affect Americans since Congress enacted Medicare in 1965. How will the law, with all its complexities, affect them? For many, the most important question to be answered is: How much will it cost?

One group the Obama administration hopes will sign up for health insurance in the new marketplace opening next month are young adults between 19 and 34, the so-called “young invincibles,” whose attitude about health insurance was presumed to be: “It won’t happen to me.”

But a Kaiser Family Foundation poll finds that more than three-quarters of young adults regard health insurance as important. Carmella Guiol is one.

“I’m worried because in a few months I’ll no longer be on my parents’ health plan. I’m using the time I have left to go to the doctor as much as possible,” says Guiol, 25, who makes preserves and raises chickens at her Coconut Grove home. The Affordable Care Act enabled Guiol to remain on her parents’ insurance plan after college — but that benefit ends when an adult child turns 26. Now, under the latest provision of the law, she’ll be able to sign up for individual insurance on the marketplace.

“My only alternative would be not to have health insurance,” she said.

She hopes the health plans on the new exchange will be compatible with her preference for alternative treatments, a preference shared by four in 10 Americans, according to the National Institutes of Health. The ACA encourages those benefits with a clause requiring insurance companies to reimburse any health provider with a state-recognized license. Cigna, for one, will cover the treatments when they’re medically necessary and offer a discount program for people who want to use them to maintain their health, a company spokesman said.

Accidents or sudden illnesses concern two-thirds of the young invincible age group, according to Kaiser. But Guiol — who has worked as a farmer, a baker and a nanny, all without an employer health plan — doesn’t have hundreds of dollars a month to spend on coverage.

Her income may qualify her for a federal subsidy. Subsidies will be offered on a sliding scale for those between 100 percent and 400 percent of the federal poverty level. The poverty level is $11,490 for an individual and $23, 550 for a family of four.

Guiol is also considering enrolling in a catastrophic plan, available for people 30 and younger. Under the healthcare law, such a plan would cover essential health benefits, but only after out-of-pocket cost sharing reaches a high deductible. Her backup plan? Having a French father, she was able to obtain a European Union passport to have access to European healthcare.

But other “young invincibles” aren’t so interested in spending money for insurance. At 28, Edward Escobar has been uninsured for two years, but not for lack of funds. “The idea of just giving away my earnings to an organization that doesn’t have my best interest at heart isn’t a good definition of using my hard-earned money wisely,” said Escobar, a Miami real estate agent.

He sees putting his money into advertising to sell more real estate as a better investment. Personal experience with the high cost of medicine has made Escobar reluctant to pay into the system. When his grandmother was in the hospital, he saw bills charging her almost $100 for a Tylenol pill. “Because it lies in a hospital, it costs more? To me, that’s price-gouging.”

While he supported the ACA, even writing to urge his congressional representatives to vote for the law, Escobar sees it as the first step in a process. “All we’ve done so far is give insurance companies and hospitals a new pool of people who need their services,” he says, while the cost of the services continues to escalate. He doesn’t think he’ll need those services anytime soon. If he has an emergency: “I’ll pay the hospital back on whatever terms we can negotiate.”

A high-deductible catastrophic health plan might make Escobar take a second look at the health exchange, but only if the cost is low enough — he’s willing to pay no more than $25 a month, he says. He might also reconsider when confronted with the penalty for those who opt out of insurance. Under the law, the penalty in 2014 will be $95 for an adult or $47.50 per child, for a total of up to $285 for a family or 1 percent of income, whichever is greater.

“I’ll have to talk to my accountant,” Escobar said.

Protecting assets from high healthcare costs is something people in Steve Hagan’s over-50 age group can relate to. A Miami public parks activist who has been self-employed as an importer since he was Escobar’s age, Hagan bought individual insurance until he turned 50, when his premium skyrocketed. He was told that in 10 years the rate would be more than $1,000 a month.

So Hagan switched to a bare-bones plan, a strategy many employ to build their savings for retirement. Even then, the premium crept up to $600 a month. Regular checkups would have told him his cholesterol was creeping up, too, but his plan was for hospitalization only, and there was no room in his budget for routine care, he says.

One Friday night, Hagan felt pains in his neck and arm. The heart attack was mild. His three stents cost the insurance company $9,200. Had he been uninsured, he would have been charged $109,000, according to what he says the hospital told him. In 2010, Hagan got his first wellness exam in 12 years, a benefit of the ACA, which required all health plans to cover preventive care such as physical exams. In 2014, he’ll have prescription coverage, one of the “10 essential benefits” that all health plans must provide under the law. He currently buys his prescriptions on the Canadian market for what he says is a fraction of the U.S. price.

The ACA will also limit what an insurer can require him to pay in out-of-pocket costs — deductibles and co-payments — to a maximum of $6,350 for an individual. For a family, the amount is $12,700. People in group plans will have to wait for that benefit until 2015.

Hagan’s premiums will be higher than Guiol’s and Escobar’s because of his age, unless he qualifies for a subsidy, but he could still see substantial savings under the ACA, because people over 50 can’t be charged more than three times the rate of young people for the same health plan.

Will he bite? He’s not sure. Now 64, Hagan will qualify for Medicare in a few months. “My insurance on Medicare will drop to $150 a month. It will be like getting a $600 raise,” he says.

Health premiums may have cost him more than he wanted to pay, but some people are unable to get coverage at any price.

“Thank you for your application for health insurance coverage,” began the letter addressed to Deborah, a 47-year-old healthcare professional who asked not to use her full name because she’s looking for a job and worries that her medical condition will be held against her. “Unfortunately, we are unable to provide health coverage to you for the following reason …”

When Deborah was first diagnosed with Stage 2 breast cancer, the nursing professional from Plantation was covered by health insurance from her employer. When the cancer returned, she had gone back to school to become a nurse practitioner, so she was covered under the school’s health plan. But since graduation in 2012, Deborah has been refused health coverage by every health insurer she’s applied to. She says she drained her 401K to pay for her care.

Families USA, a national nonprofit focused on affordable healthcare, estimates that more than 7.8 million Floridians have a preexisting condition such as diabetes, high blood pressure, asthma or, like Deborah, a history of cancer. Starting Jan. 1, under the ACA, companies must accept everyone. No one can be denied or charged more because of their condition. Nor can coverage be cut off if you get sick.

The Obama administration hopes to draw another group into the health exchange: people climbing out of poverty into the lower middle class who have never been able to afford coverage. The lunchroom at Plants In Design, a bromeliad nursery in Homestead, fills with conversation as workers from a half-dozen Latin American countries file in from the greenhouses. The 49 employees — all with full-time jobs, vacation pay, overtime and bonuses, but no health insurance — are among those likely to qualify for the highest health premium subsidies under the health reform act.

Today, Rosa Corea’s three children are covered by Medicaid. Healthcare for her and her husband, who packs vegetables, consists of exams at a sliding scale clinic, and getting charged full price for everything else.

When her husband was in a car accident and went to Homestead Hospital, “They ran tests, sent him home, and charged him $36,000,” Corea says. His car insurance covered half the bill. Two years later, he’s still paying off the balance in $50-a-month installments arranged with the hospital.

Corea heard about the ACA on the news and knows she’s required to get health coverage. She’d like to be able to see a doctor and have hospital care if needed, but worries she can’t afford it.

“Without insurance, we could keep doing what we do now. You always look for the most economical thing to do.”

Corea’s employer, Ashley Trop, is on the same page when it comes to doing what’s most economical. “If I had 50 employees, I’d be freaking,” says the former firefighter and attorney, referring to the ACA mandate that employers with more than 50 employees must insure them or pay a fine.

While the plant nursery is profitable enough to provide the coverage, he thinks all his employees will qualify for subsidies. In Corea’s case, a subsidized health plan could cost less than $40 a month, according to estimates provided by the Kaiser Family Foundation subsidy calculator recommended by the official ACA website, .

But Trop doesn’t want his workers to pay out of their pockets. He thinks a $1,000 annual raise, which he’s willing to give each of them, would be enough to make up for their premiums.

“Call me a burned-out hippie, but I believe in a living wage,” he says.

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Enroll America organizer Juanica Fernandez networks with fellow field staff as the non-profit organization prepares to educate Floridians about their health care choices under the Affordable Care Act. Rodriguez will be reaching out to residents throughout Orlando (Photo by Patricia Borns/for the Miami Herald).

With a Jan. 1, 2014, deadline for most Americans to get heath insurance coverage, Floridians who aren’t already insured or don’t qualify for Medicaid will need to choose a healthcare plan, either from the private market or from one of the new healthcare exchange plans that will be available on Oct. 1. While the plans don’t exist yet, and even the “navigators” who will help Floridians understand the new marketplace aren’t yet known, Enroll America and other groups are wasting no time getting the healthcare word out.

“Seventy-eight percent of Americans have no idea there’s a health marketplace,” the organization’s state director, Nick Duran, told the group assembled in a small United Way conference room. Team members, many hired within the past two weeks, must be ready to recruit and train volunteers, bring local partner organizations on board and start knocking on doors by the statewide “weekend of action” event starting July 27.

Nationally, Enroll America is funded by Kaiser Permanente, Families USA and other top donors to President Barack Obama’s 2012 campaign.

Jimmy Tan, the organizer responsible for reaching out to residents in Miami-Dade County — Enroll America’s most critical Florida region — is a veteran of Obama’s 2012 Organizing for America campaign in Florida. Tan’s staff of seven were chosen for their grassroots organizing experience in targeted Hispanic and Haitian neighborhoods, where they’ll be recruiting volunteers and partner organizations to help spread the word.

Florida Organizing Director Ray Paultre, who helped kick off the training session, said he expects educating people on healthcare reform will take six or seven conversations per person to reach each “target” in his organization’s database, which includes hundreds of thousands across the state. The conversations are aimed at individuals and families whose incomes would qualify them to receive federal tax credits to offset the cost of a healthcare plan.

Others besides Enroll America are getting into the consumer education act, including insurance giant Florida Blue, which will be participating in the new healthcare exchange.

“One of the interesting things is that only 10 to 15 percent of Americans have ever purchased their own health insurance policy. Most go through their employers or are uninsured,” said Florida Blue chief strategy and marketing officer Craig Thomas.

To help them, Florida Blue plans more than 3,000 seminars to demystify the new health reform guidelines.

While the training session had the earmarks of an efficient political machine, Enroll America organizers say their mission has no party affiliation. “When the conversation is about healthcare, people tend to leave their politics at the door,” Paultre said.

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