Workplace Fatalities.

The Bureau of Labor Statistics has never been off of the mark;

their numbers for workplace necrosis continues to grow rather stark.

Each year sees mortality rising in workplaces throughout the land.

Who knows when the hourglass mayhap at your job run right out of sand?

Seeing that labor so steady is often a hazardous plan

I’ve made it my practice to goldbrick and live to become an old man. 

Want Free Room & Board in a Gorgeous Mansion? Try House Sitting! by Susan Caba.


I am living the life of the rich and famous, although I am neither.

I’m following good weather and my whims around the country, moving from one luxury home to another. My accommodations last year have ranged from a mansion in Washington, D.C., around the corner from the home of former Senator John Glenn, to a woodsy retreat in Chapel Hill, N.C., to a sprawling Philadelphia condo with an exclusive Rittenhouse Square address.

At the moment, I’m living in a hillside house in Santa Barbara, Calif. The scarlet bougainvillea, attended by hummingbirds, competes for sunlight with the lavender blooms of jacaranda trees and spiky purple agapanthus in the garden. The Pacific is an indigo wedge on the horizon. I’ll swim a few lengths of the pool — no suit needed — before showering in a spa-like master bath with heated floors. For these two months, I’m driving a vintage white Mercedes nicknamed the Sugar Cube.

My cost for living in this Southern California splendor? Nothing. I tend three cats, feed a tank of fish and mist the Boston ferns in return for lodging. I’m a house sitter, part of a thriving network of full- or part-time vagabonds.

House-sitting is one more example of the upending of the travel industry by the combination of social networking and the sharing economy. The difference between house-sitting and companies like Couchsurfing — in which the person who owns the home is paid — is that no cash is exchanged. Neither I nor the homeowners I sit for spend any money.

I started house-sitting inadvertently, when an acquaintance in Santa Barbara wanted someone to mind her cats for two weeks. She had tapped out her family connections. I was already spending four to six weeks of every winter and summer — when the weather in St. Louis is either lethally cold or horrifically hot — in California, so I jumped at the chance. We’ve repeated the arrangement every year since, with the length of her vacations, and mine, gradually growing. That got me wondering about other house-sitting opportunities.

I listed my availability on Craigslist; no response. I considered contacting universities, looking for professors going on sabbatical, but that seemed like a lot of trouble. Eventually I Googled “house-sitting” and found several websites that registered ­homeowners and house sitters. They cost between $10 and $100 a year for membership, which gives you access to the listings.

Homeowners post descriptions of their homes and pets, as well as the dates they need a sitter, anywhere from a weekend to several months. Potential sitters provide a brief profile, any house-sitting experience, contact information and references. Reading the listings is like being addicted to gumdrops: Do I want three weeks in a house with a horse in Brittany, or a month in Costa ­Rica on an estate overlooking the Pacific Ocean?

After more research, I joined two sites:, a three-year-old organization based in Britain, and, based in Australia and in business since 2000. Both list house-sitting opportunities in the United States, Australia, Britain, Costa Rica, Continental Europe and, to a lesser extent, other places around the world.

Why, you may ask, would anyone entrust their home and possessions to strangers?

Some homeowners, especially those who will be gone a significant amount of time, just want their houses occupied as a security measure (statistically, an occupied house is safer than one left empty). That was the case for my stay in Washington. I arrived just after the last snowstorm, in April, and left before the onslaught of summer.

But pets are the reason for 80 percent of house-sitting arrangements, said Andy Peck, the founder of TrustedHouse­, who started out house-sitting on a multimillion-dollar estate in Spain.

“People want their pets to be comfortable, in their own environment,” he said. “From the sitter’s point of view, there are a lot of people who genuinely love looking after pets, especially while having a ‘staycation’ and enjoying luxury, sometimes decadent luxury, while living like a local in a fantastic place. It’s a win-win for both sides.”

So far, I’ve cared for cats, some fish and one dog. I get a lot of laughs reading the descriptions of required pet care, from clipping the nails of 13 indoor cats to nursing a diaper-wearing, diabetic dog through his final days while his owners jet off to Costa Rica. One homeowner sought care for “4 horses, 2 dogs, 8 cats and a pet pig who lives in the house, in addition to chickens and ducks and 2 very friendly goats.”

As for the trust issues, the websites don’t make any matches or vouch for the accuracy of the listings. It’s up to sitters and owners to find one another through the listings, then vet one another by exchanging emails, talking by Skype or telephone and, in some cases, meeting in person. The sites strongly encourage sitters to post references and even undergo police background checks. They provide sample agreements spelling out the responsibilities of both parties.

Retiring baby boomers and workers in the freelance economy who, like me, can do business anywhere with a laptop and a smartphone make up the primary supply of house sitters. Families looking to take interesting vacations during school holidays are another source. (Homeowners specify whether their property is suitable for children, and many encourage families.) The same groups are often looking for house sitters themselves.

There are risks on both sides of the arrangement. Besides theft or damage, there’s the possibility that sitters will cancel at the last minute, ruining expensive travel plans. Sitters, too, may face the unexpected. A friend of mine agreed to move into a Victorian house in Colorado for a month, only to find that one of the two dogs she’d be watching was a snarling hound of the Baskervilles.

My only mishap was being caught skinny-dipping — twice — in Santa Barbara. The Guatemalan pool guy unexpectedly changed his schedule so he could watch the World Cup. At least I was in the deep end.

Last year, I sold my house and unmoored myself from any one location, to indulge my wanderlust for a year. I’m already booked through February. I’ve had to pass on that house with the Pacific Ocean view in Costa Rica, a month in Boston’s Beacon Hill and a cottage in the Cotswolds. I’m beginning to think that a year might not be long enough.

On Welfare? Cheer up; You’ll Soon be Feasting on Wild Alaska Salmon!

Would you like the wine list?
Would you like  to see the wine list?

Just more than a month after Senator Lisa Murkowski urged the U.S. Department of Agriculture to consider Governor Sean Parnell’s proposal to use existing federal funds to buy extra Alaska canned pink salmon for The Emergency Food Assistance Program (TEFAP), USDA Secretary Tom Vilsack has agreed to purchase up to $13 million worth.  This news is welcomed by Alaska’s seafood industry, which has been burdened by a glut of pink salmon from last year’s record harvest, and boosts the nutrition options for low-income Americans facing the lingering recession.


“For countless Alaskans and Americans nationwide, the economy is still not working for them; food banks nationwide are seeing increased numbers of those seeking emergency food assistance,” said Murkowski.  “Knowing that Alaska’s seafood warehouses have tons of excess canned pink salmon seemed a great fit to clear their shelves and help feed Americans with one of the most natural and nutritious options out there.”


On July 29th, Senator Murkowski reached out to USDA Secretary Vilsack in support of Governor Parnell’s request pointing out that the unsold salmon inventory was harming this season’s economic prospects.  In her (attached) letter, she wrote:

“In addition to the benefit such a purchase would bring to the Alaska fishing industry, the purchase of Alaska pink salmon … would result in important health benefits for the low-income Americans who rely on USDA-supported food assistance programs.”

The news was welcomed by Food Bank of Alaska, as well.  “We’re so happy to see Secretary Vilsack understands the value of Alaska’s nutritious and tasty salmon as a source of much needed protein for our struggling neighbors,” said Food Bank of Alaska Executive Director Michael Miller.  “We’re seeing record numbers of Alaskans utilizing the emergency food safety net. We appreciate the leadership of Senator Murkowski on hunger issues, and Alaska’s seafood industry will also benefit from this purchase. It’s a win-win.”



This blog is brought to you by Maceys Supermarkets, where their famous case lot sale continues until September 15th.  You are always guaranteed low prices and friendly service at Maceys.  Voted “Best Apple Fritters in Utah” by the Utah Bakery Association five years in a row!


Veterans Are Dying to Get Into VA Hospitals — Literally!


Sen. Chuck Grassley of Iowa today made the following comment on the interim report from the Department of Veterans Affairs inspector general on medical care wait times at veterans facilities.  Grassley has co-sponsored legislation that would make it easier to fire senior employees at the department for poor performance.  He also urged the Veterans Affairs secretary not to allow employees to be assigned to long periods of paid leave as a result of the scandal that, in effect, result in extended paid vacations.  When the allegations were first reported about the Veterans Affairs hospital in Phoenix, he called upon the inspector general to conduct a thorough nationwide review of the Veterans Affairs health care network.

The report is available here.

“Today’s report shows false wait times aren’t isolated.  The false wait times are systemic.  By any measure of common sense and human decency, putting the health and welfare of those injured while serving their country at risk by manipulating appointment records is unconscionable and unpatriotic.  The inspector general’s continued work is critical to learning whether the delays for treatment led to preventable deaths. When the inspector general completes his work, all responsible employees have to be held accountable for their actions at all levels of the VA.  The stakes are too high for anyone to duck accountability.”

Native American Children Face Incredible Challenges.


Senate Committee Passes Heitkamp’s Bipartisan Bill to Stand Up for Native American Children

Senator’s Bill Moves to Full Senate, Bolsters Effort to Reduce Poverty, Substance Abuse & Domestic Violence in Indian Country

WASHINGTON, D.C. – During a Senate Committee vote, U.S. Senator Heidi Heitkamp’s bipartisan bill to create a Commission on Native Children overwhelmingly passed – the final step before the bill goes to the full Senate.

Since the bill was introduced a few months ago, Heitkamp has worked to build strong support for it. The bill now has 27 cosponsors, bringing together conservative, moderate, and liberal Senators looking to stand up for Native children and make sure they have every opportunity to succeed. In October, Heitkamp introduced the bill with Republican Senator Lisa Murkowski, and today it passed in the Senate Committee on Indian Affairs.

Specifically, the bill would improve the lives of Native American children by examining and addressing high poverty rates, unemployment, child abuse, domestic violence, substance abuse, and few economic opportunities – and make tangible recommendations on how to make sure they are protected and supported.

“For far too long, we have tiptoed around engaging in an honest conversation about the incredible challenges kids face in Indian Country,” said Heitkamp. “But today, we carved a path forward by overwhelmingly advancing my bipartisan legislation that stands up for them – because supporting Native families and children should be an issue all sides can agree on. I will never give up or stop fighting for Native children and now it’s on us, as a society and as leaders, to make sure we don’t forget or lose our sense of responsibility when it comes to protecting and supporting Native children. Thank you to those who have worked so tirelessly to reach this point, but we are not yet finished. I look forward to doing everything in my power to continue this momentum, pass it in Congress, and see this bill signed into law.”

Senator Jon Tester (D-MT), Chairman of the Senate Committee on Indian Affairs and cosponsor of the legislation, reinforced the importance of passing Heitkamp’s bill.

“It’s unacceptable that so many Native children find themselves without the opportunity to succeed,” Tester said.  “Tribes across this nation have a proud history and tradition, and Senator Heitkamp’s bill will allow them to find more ways to improve the quality of life for future generations.”

Since her time as North Dakota’s Attorney General in the 1990s, Heitkamp has worked to stand up for Native families. When she introduced her Commission on Native Children bill in October 2013, Heitkamp spoke on the Senate floorabout the importance of this legislation to address some of the most pressing challenges for Native children. The bill has the strong support of all five tribes in North Dakota and many national Native American organizations.

During a Senate Committee on Indian Affairs hearing on the bill in April, former U.S. Senator Byron L. Dorgan testified at the request of Heitkamp to discuss how Heitkamp’s bill would make real changes to help improve the lives of Native American children. Dorgan is the former Chairman of the Committee, and the Founder and Chairman of the Center for Native American Youth at the Aspen Institute.

Heitkamp’s bill, the Alyce Spotted Bear and Walter Soboleff Commission on Native Children, would conduct a comprehensive study on the programs, grants, and supports available for Native children, both at government agencies and on the ground in Native communities, with the goal of developing a sustainable system that delivers wrap-around services to Native children. Then, the 11 member Commission would issue a report to address a series of challenges currently facing Native children. A Native Children Subcommittee would also provide advice to the Commission. The Commission’s report would address how to achieve better use of existing resources, increased coordination, measurable outcomes, stronger data, stronger private sector partnerships, and implementation of best practices.


Children in Foster Care are Often Heavily Drugged.


Senators Highlight New GAO Report on Improper Prescribing of Psychotropic Drugs to Foster Children


WASHINGTON – Today, Senator Tom Carper (D-Del.), Chairman of the Homeland Security and Governmental Affairs Committee and Senator Ron Wyden (D-Ore.), Chairman of the Senate Finance Committee,  held a press conference to release a new Government Accountability Office (GAO) report on the ongoing risk of improper prescribing of psychotropic drugs to America’s foster children.


This GAO report was requested by Sen. Carper, Sen. Susan Collins (R-Maine), Sen. Chuck Grassley (R-Iowa) and Sen. John McCain (R-Ariz.). The report is a follow-up to GAO’s 2011 study that found that psychotropic drugs may be overly prescribed to our nation’s foster youth. Today’s report contains case studies highlighting individual children’s medical and psychological treatment while in foster care and concludes that additional efforts may be needed to address the problem.


“Today’s GAO  report reminds us that improper prescribing of mind-altering medications to our nation’s foster youth has not gone away,” said Chairman Carper. “For some problems, medications simply are not the only solution. Often times, foster children are suffering through the after-effects of deeply traumatic experiences such as abuse and neglect. It is critical that we understand and address these underlying problems first, and not simply hope the problem will go away with medication.  I am encouraged that the Administration and the Department of Health and Human Services kept its word and worked with states to help curb this problem, but this report showed that more work remains. I will continue our Committee’s oversight on this issue and work with the Administration, states, and stakeholders like Casey Family Programs to ensure that we focus like a laser on getting these children the support they need.”


“It’s clear that too little is being done to oversee the use of psychotropic medication among kids in foster care,” Sen. Wyden said. “These children are often victims of intense trauma, and their pain cannot just be prescribed away. A number of states and advocacy groups are working hard to better serve children in foster care, and it’s time to build upon those efforts to make sure every child’s unique needs are appropriately addressed.”


“We have a fundamental responsibility to provide for the health and well-being of the children in foster care in the United States,” said Senator Collins.  “This includes ensuring that they are not inundated with unnecessary medications.  It is encouraging that, as a result of a law passed by Congress in 2011, this report finds that states have begun implementing policies to better regulate the use of psychotropic medications for foster children.  We must, however, continue to provide strong oversight of the care provided to children in foster care.”


“The federal Department of Health and Human Services should build on its prior work and lead the states in getting good results for foster youth in this area,” Senator Grassley said.  “The federal government should issue guidance, as recommended, and help states share best practices with each other.  It can be a clearinghouse for solutions that states can use to help both foster youth and their own Medicaid budgets.”


Christine Calpin of Casey Family Programs, and Jen Hope Radimaker and Dashun Jackson, two former foster youths, joined Chairmen Carper and Wyden in highlighting the challenges facing the foster care system.


“At Casey Family Programs, we believe there is a tremendous opportunity today to improve our nation’s approach to financing child welfare so we can better support the kinds of specialized therapies that are proven to lead to better outcomes and enable more children to remain at home safely with their families,” said Christine Calpin.


“Often times, the type of therapy treatment that I was given only focused on my behaviors,” said Jen Hope Radimaker, a former foster child.  “Foster youth often have trauma in their lives that is never addressed.  I look at it like a weed.  Therapy and meds focus on pulling off the leaves and pulling at the stem but if you don’t get to the root of the problem- the trauma- then it will keep growing back.”


The GAO report concludes that while the Department of Health and Human Services (HHS) has endeavored to provide guidance regarding oversight of psychotropic medications for foster youths, additional guidance is needed, particularly on oversight of prescription drugs through managed-care organizations, which are being utilized by an increasing number of states.




For a full copy of the 2011 GAO report, click here.









Medicare Fraud Still on the Rise.

WASHINGTON, D.C.  – As law enforcement announced a nationwide sting against Medicare fraudsters, a bipartisan group of lawmakers was putting the finishing touches on legislation aimed at making a significant dent in the problem. 
Justice Department officials announced that they had arrested 90 people, with more than half being from South Florida. The arrests were on charges related to defrauding $260 million from the Medicare program. 
“This is exactly why we’re doing the legislation,” said U.S. Sen. Bill Nelson (D-FL) who chairs the Senate Special Committee on Aging.  “We’ve got to get this problem under control.”
Nelson’s legislation would require Medicare to verify that those wishing to enroll in the program have not owned a company that previously defrauded the government.  The bill also will allow private insurers to share information about potentially fraudulent providers with Medicare, and requires new medical coding systems to be tested before they’re deployed to ensure Medicare’s fraud prevention systems work properly.
The bill is co-sponsored by Sens. Sue Collins (R-ME), ranking member of the Aging committee, and Chuck Grassley (R-IA) and Tom Carper (D-DE).
According to at least one recent estimate, fraud in the country’s Medicare system takes some $60 to $90 billion out of the system and puts it into the pockets of crooks.
The lawmakers are planning to formally file the bill on Thursday.  The legislation is expected to garner support from various consumer and industry groups.

Attached is a summary of the bill:


Sponsors: Sens. Bill Nelson, Susan Collins, Tom Carper, Chuck Grassley


The Medicare program is particularly vulnerable to fraud as it goes through significant changes and implements a variety of new policies.  Among these is the future adoption of new code sets; new provider enrollment procedures; limited resources; and the ever-increasing sophistication of Medicare fraud schemes.  The Medicare program needs to carefully test new systems to assess their impact on detection and prevention of fraud prior to deployment.  It needs to be able to better identify and keep out of the program those who have a known history of defrauding the government.  And finally, it needs to know how much fraud is in the system, and what its greatest vulnerabilities are, to target resources effectively.


  • In FY 2012, the Justice Department opened 1,131 new criminal health care fraud investigations involving 2,148 potential defendants, and a total of 826 defendants were convicted of health care fraud-related crimes during the year.
  • According to at least one estimate, Medicare fraud is estimated to cost taxpayers $60 billion to $90 billion each year.


The Stop SCAMS Act of 2014 helps safeguard taxpayer dollars and reduce fraudulent payments by:


Allows private insurers to share information about potentially fraudulent providers with Medicare and each other to prevent health care fraud — Coalition Against Insurance Fraud’s testimony supports this public-private partnership.


Under Medicare currently, providers who previously had an ownership interest in an organization that defrauded the Medicare program could potentially get back into the program by using a different name and failing to disclose their interest in the previous organization — how the Wolf of Wall Street’s business partner allegedly defrauded Medicare after failing to disclose his ownership interest in the company.   The bill would require Medicare to verify provider ownership interests using other databases, including information obtained under the Physician Payments Sunshine Act.


Require full end-to-end testing of code sets before implementation of the new codes, to ensure that payments to providers are not delayed and fraud prevention systems continue to work appropriately.  Before HHS could implement any new coding system, it would be required to certify to Congress that all testing had been completed, and plans were put in place to remediate any impact on the timely payment of legitimate claims.


Allow the Medicare Payment Advisory Commission to make recommendations regarding fraud prevention, and require the Medicare program to develop a strategy for reliably estimating the amount of taxpayer dollars lost each year to fraud.


National Healthcare Anti-Fraud Association, Coalition Against Insurance Fraud, the National Insurance Crime Bureau, America’s Health Insurance Plans, Humana and the Blue Cross Blue Shield Association.

Lee Introduces Head Start Reform.



WASHINGTON – Today, Senator Mike Lee introduced legislation to reform the early childhood education program known as Head Start.  The Head Start Improvement Act is intended to produce better results by offering states and parents greater flexibility to tailor the program to meet the specific needs of low-income children.  A 2012 study by the Obama administration showed that, despite spending $8.6 billion per year on education, health, nutrition, and other services, the program produced no lasting benefits.

“Underprivileged children need access to good education, and the scientific evidence shows the federal government does a lousy job of providing it,” Senator Lee said. “Education reform should empower principals, teachers and parents, instead of centralizing power and money in political bureaucracies. This bill would allow states, communities, schools, and families to better tailor pre-K programs to the specific needs of each eligible child.”

Confronted with the obvious failures of government programs, many states are already looking at ways to better serve their low-income populations.  For example, the Utah state legislature has created a special task force to study the prospects of “charity care” – affordable medical services for poor families provided not by government but by individuals, businesses, non-profit groups, and local communities.

“The Utah Model might not work in every state, but every state should have the freedom to solve problems their own way, according to their own values and priorities,” Lee added.


How it Works:

  • Provides Head Start block grants directly to eligible grantees, which include states, territories and federally recognized Indian tribes.
  • Restores the responsibility to each recipient grantee to define what entities within their state would be eligible to receive sub-grants; award sub-grants to those eligible entities; establish rules and standards for the entities awarded sub-grants; and monitor compliance with state rules and standards
  • Eligible grantees receive an allotment of the Head Start funds in proportion to the number of children aged 5 and younger from families with incomes below 130% of the poverty line residing within their State.
  • Eligible grantees must provide a 20% match to all Federal Head Start funds granted, consistent with current law.
  • All funds must be used for prekindergarten education, administration of the programs, and to provide direct technical assistance, oversight, monitoring, research and training.


What it Does:

  • Puts more money in the classroom instead of the Washington bureaucracy
  • Gives states and local officials and parents greater control over improving the Head Start program
  • Ensures the program will better serve the interest of low-income families with young children

Crackdown Proposed to Prevent Illegal Immigrants From Abusing Medicare

Is Uncle Sam getting too generous?
Is Uncle Sam getting too generous?

WASHINGTON —  The Obama administration is planning new steps to prevent people in the country illegally from obtaining Medicare after finding that tens of thousands were improperly receiving benefits.

In President Obama’s budget for 2015, to be unveiled today, and in new regulations, the administration proposes to remove illegal immigrants from the Medicare rolls and explicitly require citizenship or lawful presence in the United States as a condition of getting Medicare.

Under a 1996 law, the administration said, immigrants are generally ineligible to receive federal benefits if they are “unlawfully present in the United States.” But, officials said, many illegal immigrants have received benefits because the Medicare agency did not update its rules or policies to carry out the restrictions imposed by Congress.

Although Medicare costs have been growing slowly in recent years, the number of beneficiaries is expected to grow 35 percent in a decade, to 70 million in 2024. And the cost of Medicare drug benefits is expected to shoot up to $170 billion, from $70 billion this year.

The administration said its proposal to have illegal immigrants “involuntarily disenrolled” would save at least $67 million over five years, mainly by requiring private Medicare Advantage plans and prescription drug plans to deny or revoke coverage for people who are in the country illegally.

The inspector general at the Department of Health and Human Services, Daniel R. Levinson, said Medicare had improperly paid tens of millions of dollars a year to hospitals, doctors, nursing homes and pharmacies that had provided services to illegal immigrants.

Mr. Levinson found that the Medicare agency and private Medicare plans were incorrectly treating people in the country illegally as eligible for drug benefits and had done little to block payment of their drug claims.

In response to the findings, Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services, said she would try to recoup some of the money. And she said that Medicare computers would be instructed to deny claims for illegal immigrants enrolled in the traditional Medicare program.

But nearly 30 percent of the 52 million Medicare beneficiaries are in private Medicare Advantage plans, not traditional Medicare. And Medicare’s outpatient drug benefit is delivered entirely by private insurers, subsidized by the government.

Jenny Rejeske, a health policy analyst at the National Immigration Law Center, a legal advocacy group, said: “There’s no suggestion of fraud here. The real fraud in Medicare is by health care providers. Payments for immigrants are just a drop in the bucket compared with provider fraud.”

Medicare relies mainly on information from Social Security to identify people in the country illegally. Social Security obtains data from the Department of Homeland Security and other federal agencies. Even if immigrants have worked in the United States and paid taxes, Medicare is not supposed to pay their medical bills if they are not here legally on the days they receive care.

The new White House budget director, Sylvia Mathews Burwell, is highlighting “investments in the health care work force” to help treat millions of people expected to gain insurance under the Affordable Care Act.

The president’s budget would provide $5.2 billion over 10 years to train 13,000 new doctors, mainly primary care physicians. Mr. Obama will also seek $4 billion to expand the National Health Service Corps, increasing the number of its providers in undeserved areas by two-thirds, to 15,000, from 8,900.

Dr. Atul Grover, the chief lobbyist at the Association of American Medical Colleges, welcomed the proposals to increase the supply of doctors. But, he said, “They could be offset by cuts in Medicare support for graduate medical education.” The White House contends that Medicare overpays teaching hospitals for treating sicker patients who require specialized services.

Mr. Obama also wants to reduce scheduled Medicare payments to nursing homes and home health agencies, which the administration says have high profit margins on their Medicare business. In addition, he would impose financial penalties on nursing homes that send large numbers of Medicare patients to hospitals with preventable illnesses and injuries.

The president’s budget also includes a proposal to encourage nursing homes and home health agencies to coordinate care for patients discharged from hospitals. Medicare would make a single “bundled payment” for post-hospital care of a patient lasting two or three months. This is part of the administration’s effort to move away from paying providers separately for each service, officials said.

Mr. Obama also recycles a proposal that has languished in Congress for several years, requiring drug companies to provide additional discounts, or rebates, to Medicare for prescription drugs bought by low-income beneficiaries. This proposal is strenuously opposed by drug makers.



Obama’s Vote-Getting Tactics Struggle to Find the Uninsured

"We're giving away free health insurance, and trips to Disneyland!"
“We’re giving away free health insurance, and trips to Disneyland!”

HOLLYWOOD, Fla. — The hunt for the uninsured in Broward County got underway one recent afternoon when 41 canvassers, armed with electronic maps on Samsung tablets, set off through working-class neighborhoods to peddle the Affordable Care Act door to door. Four hours later, they had made contact with 2,623 residents and signed up exactly 25 people.

Many of their targets, people identified on sophisticated computer lists generated in Washington as unlikely to have health insurance, had moved away. Some were not home. Many said they already had insurance through Medicare, their parents or a job. A few were hostile at the mere mention of President Obama’s health care law.

“We’re going to repeal that,” one man said gruffly as he shut the door in the face of a canvasser, Nancy Morwin, 58, a retired social worker.

Such are the limits of microtargeting the uninsured as groups supporting the Obama administration take to the streets on behalf of the president’s most important domestic initiative. The nationwide effort is modeled on Mr. Obama’s successful voter turnout machines in 2008 and 2012, but in this case the task of finding Americans without health insurance and signing them up is a painfully slow grind.

Although the administration expects many enrollees to make their own way to the government’s health care website or the state exchanges, the door-to-door effort is aimed at people without computers, email addresses or the wherewithal to show up at health fairs and other enrollment events at Kmarts or grocery stores. Officials say the labor-intensive targeting program, while frustrating, could eventually add thousands of people to the rolls of the insured.

The campaign is staffed by organizations deploying thousands of paid and volunteer canvassers across the country. Planned Parenthood, one of the most aggressive groups, has raised millions of dollars for the effort. It is paying about 400 workers like Ms. Morwin $12 an hour. They are knocking on an average of 18,000 doors a day in eight states: Arizona, Colorado, Florida, Georgia, New Mexico, Ohio, Pennsylvania and Texas.

Enroll America, a nonprofit group that is trying to expand the health care rolls, has hired 266 people and recruited 14,000 volunteers to not only canvass neighborhoods but also make calls at phone banks and host events at community colleges in 11 states. The group has also spent $7 million to advertise on the Internet.

The efforts are important for Mr. Obama, who has been damaged politically by the initial failures of his health care website. Now, with HealthCare.govfinally working, his administration and outside supporters are racing to meet their goal of signing up seven million people by March 31. By the end of January, nearly 3.3 million people had enrolled. To the canvassers, at least, the original goal seems a long way off.

“Can’t sweat the small stuff, not in this biz,” Ms. Morwin said, after retreating from a run-down rental property on a modest street lined with palm trees in Hollywood, where she was once again informed that the person on her list no longer lived there. “You see the challenges I have?”

The canvassers’ lists are derived from data created at Enroll America’s offices in Washington by some of the same computer programmers who churned out the statistical models for Mr. Obama’s presidential campaigns. Using commercially available information, the data experts generate lists of people with rankings that indicate their likelihood of needing health insurance. The typical uninsured is younger, male and either low-income or unemployed.

People are scored from zero to 100, with those at the top most likely to be uninsured. By using an uninsured score of just 20 or higher, Planned Parenthood is casting a wider net to improve the chance that its door-knockers find people without insurance. In Broward County, home to 1.39 million people, the Enroll America data lists 284,000 such targets between the ages of 18 and 45.

In Florida, Planned Parenthood has turned the data into “heat maps” of the uninsured, with neighborhoods colored in varying intensities of red to indicate where most of the targets live.

“I like to think about it as a compass,” said Matt Saniie, Enroll America’s data specialist and a former member of Mr. Obama’s re-election team. “It gives you a direction.”

But on the ground, Mr. Saniie’s lists are far from perfect and offer the canvassers little more than a rough road map. There are no signs in front yards that proclaim, “I don’t have health insurance.” Some people were embarrassed and unwilling to admit they were not covered.

Others approached by the canvassers were immediately suspicious.

“Why do you have my name?” asked one woman in a house on Polk Street in Hollywood.

But the canvassers said that some of the uninsured were eager to sign up.

After more than an hour canvassing Hollywood for Planned Parenthood, Alberonick Valsaint, 42, had yet to sign up anyone for health insurance. But then he approached a small three-room house where Yersson Llabreras, 35, was putting on his McDonald’s uniform and getting ready for work.

Mr. Llabreras said that his 9-year-old son was asthmatic and that he had tried in vain late last year to sign up for coverage on the government’s health care website. “For real, we need it,” he said.

So for more than half an hour, Mr. Valsaint walked Mr. Llabreras through the process of creating an account on so he could select an insurance plan. When Mr. Llabreras had to leave for his job, Mr. Valsaint continued with Mr. Llabreras’s wife, Diana Camacho, who took a break from “Caso Cerrado,” a popular Spanish-language show similar to “The People’s Court.” The family of four is now on its way to getting health insurance.

The day before, Ms. Morwin, the canvasser for Planned Parenthood, met Francisco Padilla, 42, in a mobile home park. Mr. Padilla’s job as a forklift mechanic pays $375 a week but does not offer health insurance. Married with three children, Mr. Padilla had tried to sign up on, with no success.

“They told me I qualify for Medicaid, but I’ve been trying, trying, trying, nothing,” he told Ms. Morwin, who took his name and telephone number and promised that someone from Planned Parenthood would follow up.

By the end of her shift, Ms. Morwin had knocked on 115 doors and talked to 16 people about enrolling. Not one of them signed up.

In some cases, problems with the health care website are still frustrating the canvassers’ best efforts.

Ryanbo Morales, 27, a Planned Parenthood worker and a former campaign volunteer for Mr. Obama, searched for the uninsured one recent day with the same zeal he brought to looking for voters during the president’s 2012 re-election campaign. But when he finally found Chrystal Rhodes, 24, who said she did not work enough hours at JetBlue to qualify for its health insurance, his efforts to help her sign up on his Samsung tablet were stymied when she kept getting an enrollment error.

“This is really unfortunate,” Mr. Morales said.

Canvassers attend brief orientation sessions before they head out. In Florida, a team of Enroll America workers recently held one in Judy Cloutier’s home in Boynton Beach. “Speak in plain terms, don’t get too complicated,” Florence French, 49, an organizer, told the group.

Near the end of the day, Jack Laplanche, 63, one of the canvassers, found Lafortune Louis, 56, a Haitian immigrant who hurt his back in 2007 and lost his job laying underground pipes. He and his family have not had insurance since.

“If you get someone coming to your door, it really helps you,” Mr. Louis told Mr. Laplanche as he signed up for an enrollment event in Delray Beach.

Nicholas Duran, Enroll America’s Florida director, said his group plans to be even more aggressive before the March 31 deadline.

“The intensity is definitely ramping up,” he said, comparing the efforts to reach the uninsured to candidates’ efforts to reach voters. “They are going to hear from us multiple times between now and the end of March until they tell us they have insurance. It’s just like a campaign.”