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In Alabama, College Students Take On Challenge of Health Insurance Sign-Up

New York Times 

By: Michael Winerip

Students at the University of Alabama Honors College here are encouraged to do volunteer work in the community and on campus.

For Marlan Golden, a senior, that has included being a Big Brother; running an education project for local Latinos; serving as president of the Alpha Tau Omega fraternity; and, most recently, signing up people for health insurance under the Affordable Care Act.

For that last one, Mr. Golden, 21, has not had to leave the fraternity house. He and several other student volunteers have been spending recent afternoons signing up the kitchen help and housekeepers of Alpha Tau Omega, as well as those at other campus fraternities and sororities.

“These are people who feed us and clean up after us but have no health care,” Mr. Golden said as he and a cook sat at his laptop filling out an application.

Mr. Golden spent an hour and a half setting up a user name, password and profile for the woman, as well as guiding her through a long list of questions about her income and health habits like whether she smoked and, if so, when she last had a cigarette. (“I’m not going to lie, that would be today, Marlan.”) After studying the costs of various coverage options, she settled on a Blue Cross and Blue Shield silver plan.

By then, the woman looked drained, but Mr. Golden was ready for more. “We only have till March 31,” he said, referring to the national enrollment deadline. “We have to keep going.”

Mr. Golden is one of about 600 student volunteers from a dozen colleges around Alabama who have been trained to help enroll people for insurance under President Obama’s signature law. They have canvassed churches, job fairs, barber shops in black neighborhoods, libraries — wherever people unlikely to have health care gather.

The all-volunteer organization, known as Bama Covered, is believed to be the only group doing enrollment that is made up solely of college students. The effort has the feel of student activism from an earlier time, like the push to register blacks to vote during the civil-rights era. By the end of February, Alabama reached 84 percent of its projected enrollment goal, ahead of thenational figure of 75 percent.

The founders — Josh Carpenter, 26, a Rhodes scholar from Florence, and Daniel Liss, 25, a Harvard-educated banker from Scarsdale, N.Y. — put together the campaign in under two months. Their hope is that if they can succeed here in such a red state, the organization will be replicable around the country.

It has been a challenge. As Dr. Max Michael, the dean of the school of public health at the University of Alabama at Birmingham said, “They picked one hell of a place to try out this model.”

The governor, Robert Bentley, is a Republican in a Republican-dominated state where only 10 percent of the white vote went for Mr. Obama in 2008. In January, Mr. Bentley spent a good part of his State of the State address criticizing the new federal health law.

An estimated 643,000 of the 4.8 million Alabamians have no insurance and the state has the country’s lowest Medicaid income cutoff, according to a 2013 study by the Kaiser Family Foundation; a parent in a family of three with household income above $3,221 does not qualify.

But if Alabamians skew conservative politically, they are liberal about philanthropy, ranked near the top in national surveys of per capita giving.

By casting the enrollment drive in a charitable, rather than political, light, organizers have been able to broaden their appeal to attract students like Megan Ryan, an Auburn University junior from Enterprise who describes herself as “conservative in morals and politics.”

Ms. Ryan, a churchgoer, has helped conduct weekly information sessions at Greater Peace Missionary Baptist Church in Opelika. “It was encouraging to see faces light up when they realize they can have health care,” she said. “I feel like I’m making a difference.”

Wayne Flynt, a retired Auburn history professor, says that 70 percent of Alabama residents were born in the state. “People go way back in a place, with a tremendous sense of responsibility to community,” he said.

He is a member of the Bama Covered advisory board and teaches Sunday school at Auburn First Baptist Church. “What motivates a lot of these young volunteers,” he said, “is they come from a religious tradition that mandates they care for people.”

Representatives from two national organizations that use student volunteers to assist in enrollment — Enroll America and the Young Invincibles — say they know of no other statewide organization like Bama Covered.

Several professors of social work and public health around the state — Dr. Pamela Foster at Alabama, Emily Myers at Auburn, Akofa Bonsi at the University of Alabama at Birmingham and Tracy Pressley at Alabama State University — are permitting students to fulfill case work requirements by volunteering for Bama Covered.

Mr. Carpenter and Mr. Liss came up with the idea in November when they were in Britain: Mr. Carpenter doing his Rhodes research, Mr. Liss working for Deutsche Bank.

By December, Mr. Liss had quit his job and Mr. Carpenter, a University of Alabama at Birmingham graduate and a former state teacher of the year, took a break from his research. “This is a historic moment for our generation,” Mr. Carpenter said. “Think of being a social worker in 1936, right after Social Security was enacted.”

Dr. Michael, the University of Alabama at Birmingham dean, gave them free office space, but mostly they work out of the back seat of Mr. Liss’s 2006 Honda, where he keeps a printer, paper cutter, water bottles and thousands of leaflets, along with a suit, tie and belt for church visits.

Alabama is a small universe, and Mr. Carpenter’s family is well-connected. His father, David, a minister and an electrician in Florence, is widely known in the northwest corner of the state. That got the son an introduction to Mary Jolley, 86, a former director of economic and community affairs for the University of Alabama and a founder of a network of 14 family resource centers around the state.

“I told people, ‘You need to meet these two young men, they’re going to do great stuff,’ ” Ms. Jolley said.

Even among the mostly middle-class student volunteers there are families with no insurance. Jalisa Jordan, a junior at Alabama State, has a stepfather who is a waiter and who has seizures. “My mom is afraid to call an ambulance,” she said. “When he wakes up, he gets upset about how we’re going to pay the bill.”

Mr. Carpenter and Mr. Liss originally spoke with representatives from Enroll America, one of the bigger national organizations doing sign-up work, but decided not to partner with it because several of the leaders served in the Obama administration and the group takes money from insurance companies. “People in Alabama don’t respond to groups that are national,” Mr. Carpenter said. “We have no national names, no national funding.”

With the exception of a $25,000 grant from a Birmingham-based foundation and $12,500 from the University of Alabama at Birmingham Hospital they have almost no funding at all.

Mr. Carpenter says the power of students is that they are not easily discouraged. That was true for Katie Carter, an occupational therapy student at the University of Alabama at Birmingham, and Chidinma Anakwenze, a medical student there, who spent a recent Saturday visiting a dozen black barber shops and beauty salons in downtown Birmingham. They gave out leaflets and took names.

Andra Sparks, a municipal court judge who was getting his hair cut at New Deal barbers, told them he knew several people who needed insurance and asked that Bama Covered send a representative to his office.

Down the street, at Fashion Hair Care, the front door was locked, the windows had bars, and though the two students could see women inside getting their hair done, no one answered their shouts. “It says ‘No Soliciting’; we probably shouldn’t be doing this,” said Ms. Anakwenze, who kept ringing the doorbell.

“You’re right,” Ms. Carter said, but she continued banging on a window anyway.