SANTA FE, N.M., LOS ANGELES and CHARLESTON, S.C. (AP) — New Mexico has received a nearly $19 million federal grant to market its Patient Protection and Affordable Care Act (PPACA) health insurance exchange to uninsured individuals and businesses.

California could see more than $300 million invested in PPACA exchange television ads, online ads, billboards, door-to-door visits and other sales pitches and promotions for its state-based exchange.

In South Carolina, the federal government is pumping $3.6 million into community groups and health centers that will help promote the exchanges.

Nationwide spending on publicity, marketing and advertising to promote PPACA could hit at least $684 million, according to data compiled The Associated Press from federal and state sources. 

Total spending in states ranges from $914,000 in Wyoming to $174 million in California.

Per-capita spending ranges from 46 cents in Wisconsin to $9.23 in West Virginia.

Federal officials say marketing will be critical maximizing the number of uninsured people who use the exchanges to check their options and sign up for coverage.

Maximizing total exchange enrollment will help the uninsured and reduce the amount of uncompensated care doctors and hospitals in a state end up providing, and maximizing the number of relatively young, healthy residents who enroll should help hold down coverage costs for all people with health coverage, officials say.

In New Mexico, officials are hoping the exchange program will enroll more than 80,000 uninsured New Mexicans in insurance plans next year and up to 211,000 people by 2020.

New Mexico wants to have its own state-run Small Business Health Options Program (SHOP) exchange for small businesses. But, because of the lack of time to fully implement its computer system, the state wants to start out having the U.S. Department of Health and Human Services (HHS) run a “federally facilitated exchange” (FFE) for individuals.

New Mexico has about 400,000 uninsured New Mexicans and businesses that don’t provide insurance to their workers.

The New Mexico exchange has solicited bids from companies for advertising, education and public relations but hasn’t awarded a contract yet.

Applications also have been requested from organizations, including nonprofits and trade associations, to implement outreach programs and provide in-person assistance to those seeking health insurance through the exchange.

Jason Sandel, vice chairman of the exchange’s 13-member governing board, said New Mexico faces challenges serving people in rural areas that lack Internet service and dealing with uninsured people who aren’t computer savvy.

“What I continue to hear is that it’s incumbent upon the exchange to ensure that we have boots on the ground in rural communities across the state in a culturally sensitive kind of way. So if we’re going into a Native American community we need to be speaking with and through Native Americans and telling Native American stories and why it’s important for Native Americans to access health insurance,” Sandel said.

“And I think that effort is going to have to be expanded over what was originally conceptualized,” he said. “And frankly putting together that type of an effort in the very short amount time that we have to put it together is darn near an impossibility.”

The state had requested a $20 million grant from the federal government for promoting the exchange and its insurance options to New Mexicans. However, $18.6 million was approved earlier this month because of the government’s mandatory, across-the-board spending cuts, according to the state Human Services Department.

Under a preliminary budget prepared for the grant request, the exchange expected to spend about $13 million for marketing and education, including about $6 million for local events in partnership with counties, schools, universities, community-organizations, business and religious groups. Of that $13 million, $1 million was for outreach for Native Americans, such as efforts in Navajo Nation chapter houses, and $4 million was for advertising on television, radio, billboards and social media marketing.

The exchange budgeted another $6 million to contract with two organizations to implement the in-person assistance programs. Those vendors are expected to subcontract with community-based groups to provide the “navigators” and “assisters” — as they are known under the Affordable Care Act — to guide the uninsured through the insurance enrollment process.

“Our goal is enroll 84,000 in the first year and our efforts have to reflect that goal,” Sandel said. “We’re a little bit behind the eight ball is the way I would put it by way of time.”

Meanwhile, in California, builders of the state’s Covered California exchange face the task of reaching millions of uninsured state residents .

Covered California managers hope the exchange will serve 2.3 million people by 2017.

About one in four federal PPACA marketing dollars — $174 million — will go to California, or more than $174 million, according to the AP.

California’s per-capita ad and public relations spending will be $4.68, is among the highest in the U.S.

Additionally, the California Endowment, a private health foundation, expects to spend $130 million of its own money for ads and other enrollment efforts aimed largely at Hispanics, in a campaign coordinated with the state campaign.

“Like most public programs that have been tried in California, this could fail on the difficulty in doing outreach and enrolling people,” California Endowment spokesman Daniel Zingale said.

With food stamps and other programs that help lower-income people “we have a terrible track record in this state on public-program enrollment,” Zingale added.

Covered California has earmarked $86 million for ads. Weber Shandwick is handling advertising, and Ogilvy Public Relations is handle other types of outreach.

Weber Shandwick could earn $12 million in fees over two years. Ogilvy’s could earn $18 million.

Stanford University political scientist Bruce Cain said he was unaware of any comparable effort to sell a government program to a hard-to-target population in the state.

“The really important selling job will be with younger, healthier voters who are going to get hit with the (insurance) mandate on top of a really bad job market. Many may opt to pay the fine rather than enroll, and that could throw things off massively,” Cain said in an email, referring to the government penalty residents could face if they refuse to enroll in health insurance.

The goal is to make sure the message gets out to potential enrollees, whether they are “at work, at home or in the car,” Ogilvy project manager Kevin Slagle said.

The program also will have to overcome public skepticism at a time when polls show most Americans have a dismal view of Washington and are unaware of how to approach the health care reforms.

“If the government said Bassett hounds have long ears, people would take out their rulers to check it out,” said Jack Pitney, a political scientist at Claremont McKenna College.

South Carolina is not helping to run its exchange. HHS is running all exchange services.

In that state, HHS is sending $3.6 million directly to community groups and health centers.

South Carolina did not seek any of the millions available for exchange outreach, marketing and advertising, said John Supra, deputy director of the state’s Medicaid agency.

“When we chose to have the federal government operate the exchange, that put the responsibility for marketing and supporting it on the federal government,” he said.

South Carolina ranks 32nd in both per capita and total PPACA exchange marketing spending.

The federal government is spending 78 cents per person in South Carolina, where an estimated 20 percent of the population lacks coverage. N

The spending in South Carolina includes $2.4 million awarded to 19 health centers statewide.

Those centers operated 157 sites and served more than 315,000 patients last year — 36 percent of them uninsured.

The centers expect to use the money to hire 45 workers and help more than 41,000 residents enroll in health plans, according to HHS.

The federal government has set aside an additional $1.2 million for community groups. The winning applicants are expected to be named in mid-August.

Michael R. Blood and Seanna Adcox contributed information to this article.

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