Hospitals push insurance enrollment
But they say many unaware of state's healthcare effort
Massachusetts hospitals and community health centers are joining a major campaign to enroll residents with low and moderate incomes in subsidized insurance plans that are a key part of the state's sweeping healthcare initiative.
But even as they take to the radio waves, prepare to distribute brochures written in multiple languages, and mail out flyers, hospital executives are finding their jobs complicated by a major problem: Few uninsured residents know anything about the landmark initiative, and fewer still understand that the new law requires them to purchase health coverage beginning July 1.
"We are encountering many people who are completely unaware that there is mandated coverage," said Reynold Spadoni , vice president of strategic planning and business development at Quincy Medical Center .
"The general population finds this to be an esoteric, complicated subject, and it's easy to miss," he said.
As a result, Quincy Medical Center and other institutions find themselves engaging in the most basic of education efforts.
Spadoni said their initial message to healthcare consumers boils down to this: You have to buy insurance, and state subsidies are available depending upon your income. Signs and brochures from the insurance companies selling the coverage are on display at Quincy Medical Center and the affiliated Manet Community Health Center to help patients choose a plan, he said.
The state created the job of signing up about 500,000 Massachusetts residents lacking health insurance when it passed the healthcare law last year. It has distributed $2.7 million in grants to a variety of associations and health centers and community agencies to help with outreach and education related to the law. About 100,000 residents with the lowest incomes were eligible for coverage first, and their insurance is fully paid for by the state. Now, the state is seeking to enroll about 100,000 to 150,000 individuals with annual incomes between 100 and 300 percent of the federal poverty level, or $9,805 to $29,412 for an individual.
Four health plans are competing for the new business made possible by the subsidized insurance. They include HealthNet , part of Boston Medical Center ; Neighborhood Health Plan , which focuses on community health centers in the Boston region; Cambridge Health Alliance's Network Health , a regional system that serves low-income residents; and Fallon Community Health Plan , an HMO that is strongest in Worcester and surrounding communities. The basic elements of the plans are determined by the Commonwealth Health Insurance Connector Authority , which was created under the law to oversee its implementation.
The insurance companies are also beginning to advertise their plans to attract subscribers. But hospitals and community health centers deliver care on the front lines, and have direct contact with the hundreds of thousands of uninsured residents. That makes their help crucial in the overall marketing of the plans.
And it won't be the first time institutions that provide healthcare have played a key role in getting people to sign up for insurance. In 1997, when the state's MassHealth Medicaid program was expanded to cover more residents, hospitals enrolled more than 35,000 of the 120,000 who qualified, said Ronald Hollander , chief executive of the Massachusetts Hospital Association .
Hollander said a recent encounter with a cab driver illustrates the need to get the word out. The cabbie, who is uninsured, said he didn't know the state was about to require him to buy insurance, and that there were subsidies available. "The biggest challenge we all have is, really, public education, and doing that in a way that makes what's available as positive as possible," Hollander said.
Hospital administrators said the sign-up process is complex, and the on-line application -- available at mass.gov/connector -- requires about 20 to 25 minutes, with the help of a counselor.
Quincy Medical Center, North Shore Medical Center in Salem and Lynn, MetroWest Medical Center in Framingham, and Caritas Christi Health Care -- which operates six hospitals including institutions in Methuen, Brockton, Dorchester, and Fall River -- are among the hospitals that could have the largest impact on sign-ups because they serve large numbers of patients without insurance. Caritas Good Samaritan Hospital in Brockton is running spots in Cape Verdean Creole on a Portuguese language station in Brockton, and its director of community outreach and interpretive services, Carla Fogaren , has appeared on local cable access television channels advising people to meet with financial counselors at the hospital. Partners HealthCare , the parent corporation for North Shore Medical Center, is printing brochures to help patients navigate the process.
And MetroWest Medical Center has six financial counselors who are taking referrals from a variety of community sources, said chief executive Andrei Soran . But Soran said that even when some people are informed about the plans, they remain wary about signing up for coverage, fearing hidden costs or penalties in the fine print.
"People are reluctant to engage," he said.
Christopher Rowland can be reached at crowland@globe.com. 
