Harry Young didn’t know what the Affordable Care Act was.
Young, a 23-year-old construction worker from Miami with two children, had gone without health coverage for four years after aging out of the state’s Medicaid program for kids.
But his mother had a vision.
“God came to me in my dream and he told me that I needed to make sure my boy was healthy,” Young’s mother Sonya Merritt said on a recent Saturday at Faith Community Baptist Church, which has a predominantly African American congregation and sits in unincorporated Miami-Dade County northwest of Miami Shores.
Mother and son went to church that day not to hear a sermon from pastor Richard Dunn, a former Miami commissioner, but to sign up for insurance under the law better known as Obamacare at an event organized by Dunn and the Jessie Trice Community Health Center.
“It was easy,” said Young, who is African American, after enrolling in a plan for $43 per month with help from a trained Jessie Trice staff member. “I’m glad I listened to my mom.”
Around Miami, healthcare activists signing up low-income and minority people for insurance are turning to what they call “trusted messengers” for help: local politicians and religious leaders.
“In general, we have a couple things working against us that people with credibility and reach in the community can help counter,” said Nicholas Duran, state director for Enroll America, a nonprofit that advocates for people to enroll in coverage under the health law.
One problem, Duran said, is a lack of awareness. “What you often see in low-income communities is a digital divide,” Duran said. “People aren’t as plugged in and they just don’t how or where to sign up or what the benefits of the law are.”
Another difficulty according to Duran is a misperception of cost. “A lot of folks have no idea that financial subsidies are available,” he said. “They think this is something totally beyond their reach, financially speaking.”
In Miami, state Rep. Cynthia Stafford, D-Opa-locka, state Sen. Dwight Bullard, D-Cutler Bay, and Miami-Dade School Board member Dorothy Bendross-Mindingall convened a meeting of local pastors last month and urged them to preach the availability of healthcare to their congregations.
“You have their ears and that means you have the power,” Stafford told them.
Several pastors, including Dunn, have since agreed to host so-called “Souls to Enroll” events at their churches this year. The phrase plays on the popular campaign encouraging African Americans to vote called “Souls to the Polls.”
“I give Obamacare airtime on Sunday whenever I can and I talk it up after church too,” Dunn said.
Last year in Florida, African Americans signed up for Obamacare in numbers roughly equal to their share of the state’s uninsured population. They accounted for 19.8 percent of consumers enrolling in 2014 coverage, according to federal data, while making up 19 percent of Florida’s uninsured.
And the number of African Americans enrolling in coverage could be even greater if Florida chose to expand Medicaid eligibility to an estimated 760,000 uninsured people statewide, said Jodi Ray, director of Florida Covering Kids and Families, a University of South Florida program that received a $5.38 million grant from the federal government to help sign people up for coverage.
African Americans are disproportionately more likely to have lower incomes than whites — and many find themselves with incomes too low to qualify for subsidies under Obamacare but too high for Medicaid, Ray said.
Stephanie Jean, 28, came to Faith Community Baptist Church for the same event as Young but left without signing up.
“They told me I don’t make enough to qualify,” said Jean, a recent immigrant from Haiti. “I wanted to sign up. I have doctors’ bills I cannot afford to pay.”
“Every time I have friends coming from Haiti, I ask them to bring me medicine,” she said. “It’s much cheaper to buy there.”
It’s not clear if Floridians of color are signing up in greater numbers than they did last year because the U.S Department of Health and Human Services has not yet released state-level data on race.
But nationally, African Americans are signing up at a lower rate for 2015 coverage than they did in the first few months of enrollment last year, according to a federal report. African Americans accounted for 14 percent of people who signed up for 2014 coverage during that time period. This year, 11 percent of consumers have identified as African American.
The deadline to buy a plan is Feb. 15.
So far, Ray said that about 25 percent of clients helped by her navigators in Florida during this enrollment period have been African American.
But low-income and minority communities are more likely to seek in-person assistance, said Pamela Roshell, regional director at HHS for an area that covers Florida and seven other states.
“Signing up for health insurance is something many African Americans have never done,” Roshell said. “There’s a certain level of trust and comfort that comes along with sitting down and getting face-to-face information.”
And coverage is especially important for African Americans. “We continue to see the weight of health disparities on communities of color, which have some of the highest mortality rates from cancer and some of the highest incidence rates of diabetes in the nation,” Roshell said.
But one ambitious measure to increase minority enrollment in Miami-Dade County may have to wait for next year.
Bendross-Mindingall had proposed using the reach of the county’s public school system to raise awareness about the health law and host enrollment events for the parents of more than 355,000 schoolchildren.
But echoing concerns about possible privacy violations raised by Gov. Rick Scott in 2013, school board members declined last week to pass the proposal in its original form. Instead, the district will simply review the legality, privacy issues and appropriateness of informing parents about “all insurance options” available to them.
At a press conference to discuss minority enrollment held Thursday, that decision was criticized by Bullard, whose constituency includes much of Bendross-Mindingall’s largely African American school district.
“This was a political decision,” the state senator said. “They were putting politics ahead of people.”
Follow @MHhealth for health news from South Florida and around the nation.
This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. Christina Veiga of the Miami Herald contributed to this report.
Here’s a racial breakdown of Floridians who enrolled in coverage for 2014:
White: 53.5 percent
African American: 19.8 percent
Hispanic: 19.2 percent
Asian: 6.2 percent