Carmen Mirabal and Megan Hall are positioned at a prime corner of a farmers' market in North Providence. Behind them is a banner with pictures of smiling individuals and the name of the state's new health exchange, HealthSource RI, with the slogan "Your Health. Your Way."
"Have you heard about the state's new insurance marketplace?" asks Ms. Mirabal as a couple wanders over.
Mirabel and Ms. Hall are part of a "39 in 3" campaign launched by HealthSource RI to visit all 39 cities in the state in three months. The small state is one of just 16 states plus the District of Columbia running its own exchange. The other states opted to partner with or have the federal government run their exchanges.
When the ACA first passed in 2010, legislators expected most states would run their own exchanges. More money was budgeted for marketing state-run exchanges than the one run by the federal government. But most Republican governors opted out, leaving participating states to share far more marketing and outreach dollars.
Rhode Island, for instance, is expected to spend $2.3 million in federal money to market to the state's 122,400 uninsured. Oregon will spend $10.9 million to reach fewer than 600,000 uninsured. Texas and Florida, states with more than 6 million and 3 million people uninsured, respectively, received zero marketing dollars because they did not create their own exchanges.
Seven of the top 10 states with the highest number of uninsured people are not running their own exchanges and so have received no marketing money. In those states, advocacy groups are trying to fill the outreach gap.
The largest group is Enroll America, a nonprofit founded by former Obama administration officials. They've recruited more than 3,000 volunteers in the past seven weeks to knock on doors in 10 states that aren't doing their own marketing, and have reportedly purchased a seven-figure media buy.