California is a key state for implementing the Affordable Care Act due to its large uninsured population. The document outlines California's large-scale efforts to educate and enroll residents in Covered California and Medicaid through marketing campaigns, grants to community organizations, and partnerships with Spanish language media. These efforts aim to increase insurance rates and access to care, particularly for low-income and Latino populations in California.

1. Implementing
Obamacare in
California
USC Annenberg
School for
Communication and
Journalism
Webinar:
“Obamacare:
Enrolling America
and the Countdown
to 2014”
July 30, 2013
Richard Figueroa
The California Endowment

2. California is “Ground Zero”
• Largest number of uninsured
• First state to pass Exchange bill post-ACA
• Large, diverse population requires a
variety of outreach and education
approaches
• Aligned Governor-Legislature-Public
implementation efforts

3. Markers of Success
• Rate of un-insurance should begin to
decline
• Active oversight of rates by regulators
and the Exchange should positively
impact rate trends
• Large number of assisters
• Active use of preventive services
• Progress on the “remaining uninsured”

4. Sources of Health Insurance Coverage
in California
Source: California
HealthCare Foundation.
SNAPSHOT: California’s
individual and Small Group
Markets on the Eve of
Reform, 2011.

5. Sources of Coverage by Race/Ethnicity
Source: California
HealthCare Foundation.
SNAPSHOT: California’s
Individual and Small Group
Markets on the Eve of
Reform, 2011

6. Why We Needed the New Health Law in
California
• By 2014, it’s expected that most of the 7
million Californians who are uninsured at
some point during the year will have
access to health care due to Obamacare.
• Once fully implemented it is estimated
92% of Californians will be insured, but
that 8% is still a significant number of
Californians (including the
undocumented).

7. “10 Worst Places for Health Coverage
in the United States”
1. McAllen, TX
2. Yakima, WA
3. El Paso, TX
4. Visalia-Porterville, CA
5. Naples, FL
6. Bakersfield/Kern, CA
7. Salinas, CA
8. Stockton, CA
9. Houston, TX
10. Las Vegas, NV
Source: Gallup-Healthways Index 2012

12. Large-Scale Community Mobilization
Efforts
• Launching key milestone events
• Earned and paid media
• Community-based grants program, federally-funded at
$43M for Covered CA and $25 million for Medicaid in 2013-
2014 (funded by the CA Endowment and prospective federal
funds)
• Broad Exchange targeting and more targeted Medicaid
groups including young persons of color, homeless, persons
with limited-English proficiency and persons in or associated
with the criminal justice system
• Certified Enrollment Counselor Fees

13. Covered CA Marketing Initiatives
• Beginning Fall of 2013, Covered California is planning a compelling,
creative and cost-effective integrated marketing campaign to reach
Californians.
• To ensure the success of its education, outreach and enrollment efforts,
Covered California will use multi-ethnic, multi-language and multi-
channel paid media campaign to reach a targeted statewide audience.
• Covered California will spend upwards of $187 million over a two year
period on a variety of marketing and advertising initiatives, including:
– Community Outreach – Printed collateral provided to community organizations receiving
Covered California grant money. Local radio and print advertising will be produced to
generate interest turnout at community events.
– Certified Enrollment Counselors – Certified enrollment counselors will be provided with
printed collateral by Covered California, as well as access to an enrollment cost calculator.
– Traditional Paid Media Campaigns – Beginning this fall, the integrated campaign will
begin to air in markets across the state with the purpose of driving awareness and
encouraging Californians to enroll.

16. Certified Enrollment Counselors/
Outreach and Enrollment Grants
• Assistance delivered through trusted and
known channels will be critical to
building a culture of coverage to ensure
as many consumers as possible enroll in
and retain affordable health insurance.
• The need for assistance will be high
during the early years, with some
estimates ranging from 50% to 75% of
applicants needing assistance to enroll.

17. Certified Enrollment Counselors/
Outreach and Enrollment Grants
• Certified Enrollment Counselors trained,
certified and registered with the
Exchange to enroll consumers in Covered
California and Medicaid products and
programs
• $58 per enrolled application for both
Covered CA and Medicaid
• Covered CA Outreach Grants beginning
now, Medicaid early winter

18. Covered CA Customer Service Centers
• The Service Centers will respond to general
inquiries, provide assistance with enrollment,
support retention and help those who enroll in
Covered California with referrals to Medicaid.
• Estimate 850 staff needed for the period from
initial implementation in 2013 through
December 31, 2014.
• A significant share of staff will be hired as
permanent intermittent staff to accommodate
fluctuations in demand between open
enrollment periods and other times of the year.

19. Covered CA Sample Messages
Who is eligible?
Californians (who are legal and permanent residents) will be eligible to buy health coverage,
possibly with federal financial help, through the Covered California marketplace.
What type of insurance will be offered?
Quality health insurance. Our goal is to help your health by providing access to affordable
insurance that can’t be canceled or denied if you have a pre-existing medical condition or get
sick. The federal government will help you pay for it. Plans will cover essential health benefits
such as doctor visits, hospital care, emergency care, maternity care, pediatric care and
prescription drugs.
What is “the marketplace”?
Private health insurance companies will compete for your business in a marketplace
operated by Covered California under the federal Patient Protection and Affordable Care Act.
It will be easy for you to shop online, in person, or by phone to find health insurance that is a
good fit for you and your family. “The marketplace” refers to all of these shopping options.

20. Key Messages for Medicaid Expansion
#1 Prevention: Free annual wellness checkups
#2 Affordability: You now have access to
affordable health coverage
#3 Financial Security: Health coverage
provides me with peace of mind
“Not your mom’s Medicaid”: Low- to no-cost
Medicaid will expand (in states that have
agreed) to all under 138% FPL, including those
without dependent children.

21. The Role of The California Endowment
and Obamacare
• The California Endowment’s Health
Happens with Prevention campaign
focused on Affordable Care Act Education
and Outreach
• Biggest opportunity in 40 years for large-
scale impact on community health

22. The Role of The California Endowment
and Obamacare
• $150 million to encourage and support efforts to enroll
eligible for public programs like Medicaid and to
support advocacy efforts to maximize health care
access and services for the remaining uninsured
including:
• Funds for Medicaid Certified Enrollment Counselors
and Local Outreach Grants
• Consumer Assistance
• Spanish and Other Language Media
• Small Business Outreach

23. New Campaign
• Innovative outreach and education campaign to drive
enrollment among California’s uninsured population,
particularly Latinos and lower-income residents,
through an informative, positive and unified message
• Has two meanings: “get insured” and “make sure”
• The tagline reflects research on top messaging to drive
interest regarding access to preventive care

24. Why the Focus on Latinos?
Ethnicity
Percentage of CA
Population
Percentage of CA
Uninsured
Population
Latino 38.1 61
White, Non-Latino 39.7 24
API 13.6 9
African-American 6.6 5
Native American &
Other
2 1

25. Spanish Language Media Partnership
• The Asegurate Spanish Language Media
Partnership includes The California
Endowment, Covered California, and
media outlets Univision, Telemundo, and
impreMedia/La Opinion
• Together, the three media partners reach
nearly 100% of the CA Latino population
(15 million people)

26. Trusted Messengers
• Doctors, news anchors/media
personalities and promotores are the
most trusted messengers
• Spanish-language media, in-person
assistance, phone assistance, and
websites are the preferred sources
Source: Survey of CA Latinos conducted Feb. 2013

27. “Surround Sound” by Spanish
Language Media Partners
• Daily and Weekly
News Content
• Paid Media – TV,
Radio and Print
• Documentary
Series, TV Shows
• Outdoor and
Online Advertising
• Social Media
• Community Events:
Promotion of WE
Connect Events,
Health Week, Town
Halls…
• Phone banks
• Show Integration

28. Beyond the Latino Audience
• Nichi Bei Weekly
• Philippine News
• China Press
• Namaste USA
• Black Voice
• Filipino Press
• Viet Bao Daily
• California Advocate
• Crossing TV
• Hmong TV
• Our Weekly
• Radio Seoul
• Sing Tao Radio
• India Journal
• Westside Story
• Etc…

30. Helpful Links
• Covered California: www.coveredca.com
• Asegurate/Get Covered Campaign:
www.asegurate.com
• Federal site: www.healthcare.gov
• Health Law Guide for Business:
www.healthlawguideforbusiness.org

31. Richard Figueroa
Program Director,
Healthy California
The California
Endowment
Email:
rfigueroa@calendow.org
Phone:
916.558.6774