For a long time in this country, having a health insurance plan was similar to a decent education – if you were fortunate in life, you could get one. If you were unlucky, you couldn't.

Now, it’s more like having clothes. You need to have the right kind clothing for your culture or climate or activity. But, getting just the right clothing can be a challenge.

Here on the South Coast, Puente has been busy getting people enrolled in Covered California, the online health insurance marketplace created under the federal Affordable Care Act, as well as many other health coverage programs.

Nine out of ten Americans have some form of government insurance (Medicare, Medi-Cal, or coverage for veterans) or have an employer-based insurance plan. According to the Kaiser Family Foundation, most people who are uninsured are in low-income working families. In 2013, nearly 8 in 10 were in a family with a worker, and nearly 6 in 10 have family income below 200% of poverty. Reflecting the more limited availability of public coverage, adults have been more likely to be uninsured than children. People of color are at higher risk of being uninsured than non-Hispanic Whites.

And so, here in Pescadero, farm, nursery, and service workers, young adults, and other contract or part-time workers can fall through the gaps. According to the approximately 1,100 South Coast residents surveyed in Puente’s health survey last year, only 8 in 10 people reported having health insurance, 10% lower than the national average. Now Puente is working hard to help every neighbor find coverage.

“We didn’t get as much interest as we had expected” in Covered California, observes Molly Wolfes, Community Health Coordinator for Puente. (This is currently a statewide problem among Latinos.) There was also “a lot of confusion” with choosing the correct plan, to the point where some families had to come back to Puente several times to resolve problems and complete their applications.

Many people want to choose the right plan, or have it be comparable to their previous plan but deciding is not always that easy. And some people would prefer to sign up for Medi-Cal, which is free, but only people that fall below a certain income can qualify. “For people with higher incomes, the monthly premium for Covered California can be a hard pill to swallow. I don’t think people are used to paying that much for health care, yet most recognize that coverage is essential,” says Wolfes.

According to the Kaiser Family Foundation, people who are uninsured often face unaffordable medical bills when they do seek care. In 2013, nearly 40% of uninsured adults said they had outstanding medical bills, and a fifth said they had medical bills that caused serious financial strain.  These bills can quickly translate into medical debt since most people who are uninsured have low or moderate incomes and have little, if any, savings.

Puente, working-side-by-side with a Human Services Agency Benefits Analyst from San Mateo County, enrolled 13 locals and assisted many more with California Covered information during the sign-up period that ended at midnight on February 15, slightly more than last winter.

Thanks to Puente’s close partnership with San Mateo County's Health Coverage Unit, four Puente staff members are Certified Enrollment Counselors who can assist in enrollment in health coverage in county, state, and federal programs.

Throughout 2014, nearly 200 people who walked into Puente’s offices walked out with some form of coverage, based on their qualifications – either under Covered California, Medi-Cal, ACE (coverage for adults age 19 through 64 who are not eligible for Medi-Cal and Medicare programs, live in San Mateo County, and have low to middle income, may be eligible, regardless of immigration status) or Healthy Kids (coverage for uninsured children from birth to age 19 who are not eligible for Medi-Cal, regardless of immigration status).  According to Puente Executive Director Kerry Lobel, "Puente helps make healthcare available to all residents, regardless of immigration status, so families with mixed status or individuals who are not sure whether they should seek help can feel comfortable exploring their options with Puente."

One reason people are getting health care is to avoid paying a tax penalty imposed by the government, or because they think they can get a better deal through a different plan. Another reason is that some parents are being extra-conscientious for their children’s sake.

Some of the people who come into Puente seeking health coverage are signing up for Medi-Cal. Until recently, if you were between the ages of 19 and 64, you could not get state-sponsored coverage through Medi-Cal – one of the biggest coverage gaps in the industry. But a landmark Medi-Cal expansion in 2014 gave several million low-income Californians the chance to qualify.

Jenny Dunbar is one of them. Dunbar, whose name has been changed, is a South Coast farmer in her late twenties who gave up a job (with health care) to work as an apprentice at a local farm, where she earns a small stipend for living expenses. Many young people are in a similar situation, she says.

“A lot of us had private health insurance through our jobs or through our parents and then all of a sudden we didn’t. You’re shot out into this nebulous medical system you were never taught to navigate.”

Dunbar was left paying a small fortune each month out of pocket for health care back in August when she figured Puente might have some better options. She was right. Within 30 minutes of visiting Puente, she was all signed up for Medi-Cal.

“I can’t believe I waited so long. There’s a general sense of peace about my life now, day to day. I can take more risks in my activities, and know there’s a safety net if I need it,” says Dunbar, referring to the potential for both on-the-job accidents and activities like swimming and skiing.

Having health insurance is one thing. Using it is another. Some people are struggling to find in-network doctors and specialists that are affordable and convenient, says Beto Razo, a Benefits Analyst with San Mateo County’s Human Services Agency. He works from Puente four days a week, helping participants sign up for Medi-Cal and Covered California, as well as CalFresh and CalWorks.

Razo says many students and young adults are enrolling in health insurance for the first time. “They don’t understand how things work now, with co-pays and deductions,” he says, so he takes the time to explain everything to them. A recent study showed that students can save money by buying health insurance, as opposed to paying a fine. And getting in the habit of doing it early bodes well for their habits later in life.

“At that age they don’t go to the doctor enough. It’s nice to see them come in and be responsible for themselves,” says Razo.

To make an appointment for health coverage, call Puente at 650.879.1691.