- Associated Press - Monday, March 17, 2014

HOUSTON (AP) - Sara Rodriguez recently received a $4,000 bill for a six-hour emergency room visit to treat a fever. She says she can’t pay, but she’s also not planning to buy health insurance through the new federal marketplace.

Rodriguez, like others gathered in a Houston gymnasium listening to a presentation about the health care overhaul, says she can’t afford insurance, even for $50 a month. With two young children and barely $400 of income a month after paying rent, she struggles to feed her family.

“It’s the law, but I’m not interested,” the 27-year-old says, explaining that she attended the presentation only because her GED teacher is making her write an essay. “I cannot afford it.”

The presentation ends and Rodriguez grabs her belongings and rushes out, forgoing the opportunity to make an appointment for enrollment assistance. The crowd of about 200 quickly dwindles, with some stragglers lingering to schedule appointments.

As a March 31 deadline draws near, this is a daily reality in Texas, where nearly 1 in 4 residents is uninsured, the highest rate in the nation.

Texas stands out among the nation’s four most populous states for lagging behind on signups. California, New York and Florida have signed up far more people.

Enrollment helpers here are working days on end, sometimes with no time off, as they make a final push to get people to buy policies.

They count the small victories: If only five people come to a three-hour enrollment event but all sign up, that gets a thumbs’ up. No matter that it is just an infinitesimal fraction of the Texans who could be eligible for subsidized coverage, a figure the Kaiser Family Foundation puts at 1.8 million people.

The final weeks of enrollment are sure to be filled with frenetic activity. Mega-enrollment drives are planned almost daily. Weekend and evening events are jam-packed. Hospitals in Dallas will stay open for longer weekday and weekend hours.

At this late stage, education and outreach have largely been abandoned. The goal now is to ensure that everyone who strolls in with paperwork walks out with insurance.

“Sign up! Sign up,” is the charge guiding Benjamin Hernandez, Houston’s deputy assistant health director, as he helps with a massive effort to reach his region’s 1 million uninsured.

Texas’ large uninsured population makes it crucial to the success of the entire national program. But the impediments are many.

Some in the state’s large Hispanic population are wary of enrolling because of fears that doing so might reveal the existence of family members at risk of being deported.

As of mid-March, enrollment numbers were only slightly more than 295,000, lagging behind Florida, another state with high numbers of uninsured and a governor opposed to the program.

Texas Gov. Rick Perry has erected his own obstacles in the form of additional rules and training requirements imposed on health care “navigators.”

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