美国国家公共电台 NPR With Federal Funds Cut, Others Must Lead Health Insurance Sign-Up Efforts（在线收听）

MELISSA BLOCK, HOST:

Starting November 1, people will be able to enroll in health insurance for next year on the Affordable Care Act marketplace. In Texas, officials from the federal government used to get the word out. This year, though, that work is falling to local governments and activists. Ashley Lopez from KUT in Austin reports.

ASHLEY LOPEZ, BYLINE: Victoria Ortega is sitting at a desk with a laptop open to a spreadsheet. Her screen is full of names, and her cellphone is in her hand.

VICTORIA ORTEGA: So far I've had about 15, maybe 18 calls.

LOPEZ: Ortega works at Foundation Communities in Austin and has been calling people who currently have an insurance plan through the Affordable Care Act, also known as Obamacare. This online marketplace was created for people who don't get health insurance from an employer, Medicaid or Medicare. Ortega is letting these folks know it's time to sign up again.

ORTEGA: (Speaking Spanish) Obamacare.

LOPEZ: Ortega also stresses that people have less time to sign up this year. During the last enrollment period, folks had three months to sign up. This year, in most states, they only have six weeks.

ORTEGA: A lot of the people were not aware of the short time, and they are very interested. They really are wanting to renew.

LOPEZ: Foundation Communities is among groups in Texas working hard this year to get the word out about open enrollment. That's because the Trump administration's health department, known as HHS, slashed money for advertising by 90 percent this year. Maggie Jo Buchanan works with a group called Young Invincibles which works to get young adults signed up.

MAGGIE JO BUCHANAN: All of us nonprofits on the ground really feel that urgency and that need. You know, in past open enrollment periods, officials from HHS would be on the ground and, you know, announcing the start of open enrollment and getting media outreach. We're just not (laughter) going to see that.

BUCHANAN: In the state's bigger cities, local taxpayers are also filling in the gap.

LOPEZ: Austin is spending a lot more money this year on open enrollment. Michelle Tijerina works for Central Health, which provides health care to low-income people, funded by local property taxes.

MICHELLE TIJERINA: We'll have ads in radio - English and Spanish. We'll be on Facebook. We'll have Google ads and banners. We'll be out in the community talking to residents. We'll be in the schools.

LOPEZ: Tijerina says Central Health is also hiring twice as many people, known as navigators, to help folks sign up once enrollment starts. The Trump administration also cut Texas's navigator budget by a third. But, she says, folks in Austin likely won't feel those cuts.

TIJERINA: Because Central Health has been dedicated to providing so many local efforts to our residents.

UNIDENTIFIED WOMAN: (Speaking Spanish).

LOPEZ: Back at Foundation Communities, Elizabeth Colvin says she worries about rural parts of Texas, though.

ELIZABETH COLVIN: Because those programs have lost funding and there's no one in those communities to step up and replace the navigators who are no longer funded for those communities.

LOPEZ: These areas don't have the same local health care infrastructure. And Texas did not expand Medicaid to more low-income people under the Affordable Care Act. So the marketplace has been the main driver in lowering uninsured rates in the state in the past several years. Even with the Affordable Care Act, though, Texas has maintained the highest number and rate of uninsured people in the country.

For NPR News, I'm Ashley Lopez in Austin.

BLOCK: This story is part of a reporting partnership with NPR, KUT and Kaiser Health News.