Since October, more than 5 million people nationwide have enrolled in health insurance through Marketplaces. This could not have happened without the help of thousands of Certified Application Counselors (CACs). Last week, I had the good fortune of spending a day with 40 CACs in Columbia, Missouri at a meeting hosted by the Missouri Foundation for Health (MFH) and Community Catalyst.

The Missouri Foundation for Health provides 17 grants to support outreach, education, and enrollment work across the state. Dara Taylor and Carrie Rogers, the St. Louis,-based Community Catalyst staff, and other Community Catalyst staff in Boston provide the MFH grantees technical and moral support.

The CACs were fresh off the heels of conducting a statewide outreach and enrollment blitz held on March 8. Forty-seven events were held throughout the state where CACs enrolled hundreds of individuals and families. The meeting started with the CACs talking about their most creative outreach strategies:

  • Doug Eller from the Community Action Agency of St. Louis County described how his agency distributed 40,000 tear off posters to St. Louis businesses.
  • Layla Earl from Phelps County Regional Medical Center discussed how her agency collaborated with the local Sonic restaurant to get coupons to give to people encourage them to hear about their health coverage options. She then worked to sign up the Sonic employees.
  • The staff from Central Missouri Community Action talked about their enrollment successes resulting from a partnership with Refugee and Immigration Services.

The most powerful part of the meeting was when the CACs talked about how their work was touching people and changing lives:

  • A 27 year old woman with cerebral palsy who worked two part-time jobs and could not get health insurance because of pre-existing conditions told the councilor from Central Missouri Community Action that “this was the first day in her life that she did not feel discriminated against.”
  • A woman who lost her job and was paying $500 a month for her COBRA plan started crying and hugged the councilors from Cover Lemay when she heard that she qualified for a $250 a year silver plan.
  • The retired couple whose only income was social security disability was helped by the staff of Primaris/Knowledge Management Associates. The wife had a stroke and had medical bills that they could not pay. The husband said that he could not afford caring for his wife at home without the coverage. They qualified for health coverage on January 1.

From the discussion that followed it was clear that the CACs, many of whom had been unfamiliar with the ACA a few months ago, were becoming experts. Wells Wilkinson, a Community Catalyst staff attorney on the policy team, explained some of the most complex parts of the ACA, e.g. the relationship of Medicaid Spend down to Minimum Essential Coverage. Everyone stayed right with him, fully engaged. They all got the complexities of the ACA, such as  why two people with exactly the same family circumstances and income would have different premium levels (one was a smoker).

These CACs from the four corners of the state who have known each other for only a few months have become a passionate community supporting each other in a difficult environment. Missouri is a difficult environment in part because of the legislature’s strong opposition to the ACA. Not only has the legislature opposed expanding Medicaid, it has also passed legislation to undermine the role of Navigators, making it almost impossible for them to do their jobs. Fortunately, the Navigator legislation has been temporarily struck down and there is a strong community collaborating to make the ACA work for people in the state. 

Despite all the push back, Missouri is a success story. Thus far, 70,000 people have enrolled in the Marketplace.  Much of that success can be attributed to the hard work and courage of these CACs. They are doing God’s work.