Weeks after the federal health insurance exchange created by the Affordable Care Act launched, but while the website for the exchange remains plagued with glitches, counselors who help people navigate the marketplace are booked with appointments from open to close at a Rio Grande Valley clinic that provides that service.

“Every day is a busy day here,” said Christian Muñoz, the director of community outreach for Nuestra Clinica del Valle, a health clinic with 11 locations in Hidalgo and Starr counties.

Next door to Muñoz’s office, one of the nine certified counselors the clinic employs sat across a desk from an uninsured woman who’s been coming to Nuestra Clinica del Valle for her health needs for 10 years. The counselor helped the woman fill out a paper application for the exchange.

“I helped her apply with a paper application since she didn’t have an email account,” said Mary Castillo, the counselor. “So, she’s going to submit it, mail it in herself, and she should be getting a response through the mail.”

The meeting between Castillo and Elvira Gonzalez, 39, a permanent resident living in McAllen, lasted about 15 minutes and was conducted entirely in Spanish, as are most meetings Castillo conducts, she said. All of the clinic’s counselors are bilingual, Muñoz said.

Fluency in Spanish may be essential to serve this role in the Valley, but it is not the only criterion.

MHP, a Weslaco-based nonprofit that seeks to provide “culturally appropriate health education and outreach” using a “promotora model,” employs five full-time navigators to help people use the exchange.

“We found that promotoras are good for this role,” said Rachel Udow, the interim program director for the navigator program at MHP.

Promotoras are lay community members who have been specially trained to deliver health education and community outreach. Last week, MHP began using federal grant money made available by the Affordable Care Act to deputize promotoras as navigators for the exchanges – an approach Udow believes is effective.

“They’re from the community they serve; they’re trusted,” she said. “Everything (about the exchange) is new, and when things are new, people turn to people they trust.

“We had gone through the navigator training program, and it’s a good program,” she added. “But it’s the training for the navigator program throughout the country. The promotoras are really able to make the information useful and localize it for people here.”

MHP also works with local partners like the Equal Voice Network and the office of U.S. Rep. Rubén Hinojosa, D-Mercedes, to reach as many uninsured people in the Valley as possible.

The efforts are particularly necessary in Hidalgo County, where an estimated nearly 300,000 uninsured people live. U.S. Health and Human Services Secretary Kathleen Sebelius acknowledged to The Texas Tribune on Friday that Texas – the state with the highest rate of uninsured in the nation – will be key to the program’s success. About 6 million Texans are uninsured.

“We see hundreds of people on a daily basis who do not have health insurance,” Muñoz said.

Gonzalez, the 10-year patient of Nuestra Clinica del Valle, said she does not have insurance and she hopes signing up for a plan through the federal exchange will help reduce her costs when she needs care.

But even under the new health law, not all of the county’s uninsured will be able to get coverage. The Texas Legislature declined an expansion in Medicaid coverage, creating a gap between people whose income is too high to qualify for Medicaid and too low to afford coverage under the Affordable Care Act.  

“We’re still going to have a challenge of poor people who are uninsured who are going to have to wait for an emergency and go to a hospital,” said Ann Cass, the executive director of Proyetco Azteca, a local advocacy group and part of the Equal Voice Network.

Even Hinojosa, a vocal and consistent supporter of President Barack Obama and his signature healthcare reform legislation, downplayed the law’s effect.

“Since Texas is one of the 25 states that REFUSED the Medicaid expansion, a high number of our constituents will not be able to afford the insurance plans offered through the ACA market place,” he wrote in an email.

Well-publicized glitches in the health exchange’s website have also prevented people from signing up, as opponents to Obama’s right are quick to point out. 

U.S. Sen. John Cornyn, R-Texas, “has long advocated for greater access to quality, more affordable health care,” Jessica Sandlin, a spokeswoman for the Texas Republican, wrote in a statement. “But sadly, as we’re now seeing with the troubled roll out, Obamacare is not the answer.”

Local groups are doing what they can to overcome those obstacles.

“We’d really love to access the website – but at this point we’re just using whatever we have available to us,” Udow told the Equal Voice Hidalgo County Health Coalition at its meeting Friday.

For Muñoz, dealing with the high volume of uninsured people seeking to get coverage through his clinic is stressful, but in a good way.

“It’s been a little overwhelming, but a good overwhelming because we’re excited about the response we’ve been getting,” he said. “My concern would be if we did not have people contacting us.”

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