PERRY, Fla. 鈥� Getting people to sign up for health insurance under Obamacare is an uphill battle in much of Florida. Politicians have put up to the law from the beginning 鈥� from joining in the lawsuit to thwart it in 2011 to placing restrictions on what health care navigators can discuss with those they advise.
That means many don鈥檛 know what the law might offer them.
Obamacare is not very popular at the World鈥檚 Largest Free Fish Fry in Perry, Fla. (Photo by Eric Whitney).
So in the state that has the second highest rate of uninsured residents in the U.S., advocates are trying get the word out that an estimated 1.6 million Floridians qualify for new subsidies to make coverage more affordable.
Not everyone wants to listen. The message will be hardest to get across, many say, in Florida鈥檚 panhandle, where sandy white beaches on the Gulf Coast back up to vast pine forests. Towns are small and scattered. The area is closer both politically and geographically to neighboring Georgia and Alabama than faraway Miami.
At local events like the recent Florida Forestry Festival and 鈥淲orld鈥檚 Largest Free Fish Fry鈥� in , it鈥檚 not hard to find people like Elijah Mott, an itinerant heavy equipment operator who says he doesn鈥檛 know much about the health care law and that most of what he鈥檚 heard is bad.
鈥淚 think it sucks,鈥� he says.
The median household income in this county is about $40,000 a year. Lots of jobs here don鈥檛 come with health insurance. That means many here, like Mott, who doesn鈥檛 have steady work or insurance at the moment, probably qualify for subsidies to help them afford coverage.
But Mott isn鈥檛 buying that the health law could possibly be good for his family.
鈥淚 would have to say no,鈥� Mott says, 鈥淚 haven鈥檛 investigated deep enough to know if there is anything.鈥�
Mott, and 41-year-old Michael Dees of Mayo, who works in a paper mill, have mostly heard that Obamacare is going to increase the price of health insurance, making it more unaffordable for people like him.
Dees says he expects to be laid off soon and worries about how he鈥檚 going to buy coverage for his family.
鈥淲ho can afford $700 a month?鈥� he asks. 鈥淚t鈥檚 easier to pay for the damn penalty at the end of the year the IRS is going to charge you than pay $500 a month.鈥�
Dees says it鈥檚 news to him that the health law offers people making less than $45,960 a year help paying monthly premiums.
鈥淚 really hadn鈥檛 heard about the subsidy,鈥� he says.
Guys like Dees and Mott are exactly who health law advocates like are trying to reach. A longtime lobbyist for children鈥檚 and family issues in Florida鈥檚 capital of Tallahassee, she says it鈥檚 tough to convince people here that the law might help them.
鈥淚t鈥檚 challenging to overcome messages that are coming out of elected officials鈥� offices and a governor鈥檚 office,鈥� she says.
Florida said no to both the law鈥檚 , and to tens of millions of dollars to advertise new subsidies for those with incomes between 100 and 400 percent of the federal poverty level
Privately-funded groups like Enroll America are trying to supply the outreach and education in Florida. That includes partnering with churches like the Sanctuary at Mt. Calvary in urban Jacksonville, on Florida鈥檚 Atlantic coast about three hours east of Perry.
invited Enroll America representatives to address his congregation one recent Sunday. From the pulpit, he warns his flock of several hundred against misinformation he says opponents of the law are spreading.
鈥淧eople perish for what?鈥� he asks from the pulpit.
鈥淟ack of knowledge,鈥� comes the practiced response.
Newman tells congregants that the law helped him get coverage after a large, private insurer turned him down because of a preexisting condition.
鈥淭his Affordable Care Act is saving lives.鈥�
The message hits home with 23-year-old truck driver Anthony Person. 鈥淚 never knew what it was before until I started coming to this church.鈥� Person says. Pastor Newman, he says, 鈥渟tarted explaining it to us the way I could understand it.鈥�
Person left his contact information at the table in the church鈥檚 lobby, to get help signing up for new Obamacare coverage. 鈥淢y job is one that does not have the best benefits, so I need health insurance to cover myself,鈥� he says.
And then, there are those who might just fall through the cracks.
A float at the Florida Forestry Festival in Perry, a small town in northern Florida. People at the festival didn鈥檛 know very much about the health law (Photo by Eric Whitney).
Back in the Panhandle, resident Karen Ray wishes subsidies to help working people afford coverage had been available when she was running her small business out of Delray Beach.
鈥淭here hasn鈥檛 been a realization how many people out there are the working poor,鈥� she says, 鈥渨orking hard and not getting health care. And just living paycheck to paycheck and hoping nothing goes wrong.鈥�
Things went wrong for Ray in a big way after the BP oil spill in 2010. 鈥淚 had a beach wedding business, and it kind of went downhill after the oil spill,鈥� she says. 鈥淚鈥檝e just been trying to get back on my feet since then.鈥�
Even before the oil spill her business never generated enough income to provide health insurance the 60-year-old Ray says. She used to get coverage through her husband鈥檚 job.
鈥淚 lost my business, and my marriage, and my house, at the same time,鈥� she says, laughing wryly.
That鈥檚 left her uninsured. She knows about the law 鈥� and she also knows, that because she lives in Florida, she is unlikely to benefit from it.
If Ray lived in one of the expanding Medicaid, she would qualify for new coverage. But because , being poor alone isn鈥檛 enough to get Medicaid here. Benefits here are reserved primarily for children, pregnant women and the disabled.
And because Ray has no income, she won鈥檛 qualify for new Affordable Care Act tax credits designed to help the working poor afford private health coverage.
鈥淚 could maybe scrounge up the money to go get a mammogram,鈥� Ray says, but, 鈥渨hat if it comes back positive? What happens to me? It鈥檚 not like you can show up in the emergency and say, 鈥極oh! I have an emergency lump!鈥� That won鈥檛 happen.鈥�
鈥淚 think a lot of us are going to fall through the cracks,鈥� Rays says, 鈥渁nd I鈥檓 very irate about that, very irate about that.鈥�
This story is part of a partnership that includes NPR and Kaiser Health News, with the support from the Dennis A. Hunt Fund for Health Journalism, a program of the USC Annenberg School of Journalism鈥檚 .听