The County Council adopted an "equity and social justice" strategic plan four years ago that directs all its municipal departments to target the areas of greatest inequity in whatever they are doing. For a transit agency, that means expanding bus services to poor neighborhoods. For the health department, it means digging into the county's insurance-enrollment statistics to ferret out the populations that are under-covered.
But while the county's bureaucrats can identify the types of residents who lag behind, they can't always reach out to them on their own. "We need to have strong community organizations that can actually move their agenda, have a voice, and really kind of drive the change," says Matias Valenzuela, King County's Equity and Social Justice Manager. (Yes, that's an actual title.)
So for every niche population that shows higher-than-average uninsured rates, Pie and Venezuela have identified a trusted leader within that community to carry their message: You can have health insurance for free or at very low cost. There is no mention of political lightning rods like "Obamacare" or Medicaid. The community leaders are free to highlight their groups' unique concerns about health coverage in order to pique interest. For Latina women, it might be natural childbirth. For the gay, lesbian, and transgender community, it might be HIV treatment or even the unresolved question of whether insurance companies should cover sex-change hormone therapy.
Pie and her staff sit in the background at events organized by these leaders, laptops, and portable printers poised, ready to enroll attendees who need technical assistance. "You have to reach the uninsured where they live. We can't expect these people to always come to us," Pie says.
Most enrollees need help. It's a complicated process. The King County bureaucrats are the experts on that front, but they do not see themselves as the spokespeople for the communities they target. They want those groups to speak for themselves. Their faith in civic, church, and ethnic leaders to convey their message comes with dollar signs. Last year, King County received $1.6 million in federal grants to enroll its uninsured population. It gave $1.3 million of that money to its community partners.
County executives are aware that the highly structured cultural rituals of some of their target groups require a carefully tailored outreach. When health officials approach the Purepecha American Indian tribe about health coverage, for instance, they know they must address the men first, who will then invite the women to join in if they like the message. The Purepecha's native language also cannot be written down, so Purepecha leaders have worked with the county to come up with written enrollment manuals that mostly use pictures.
Pie's rhetoric echoes that of a civil-rights activist rather than a regulatory specialist. "Do you feel like health care reform is an equity issue? Absolutely, it has to be an equity issue," she recently told health care journalists at a conference on Obamacare enrollment. "I believe it's our responsibility to reduce disparities. Period."