North Carolina healthcare navigator

“This is personal for me,” Quinetta Rascoe says of her work signing people up for insurance under Obamacare. When she was growing up, her brother’s childhood illness put a strain on her family’s finances. (Brian Bennett / Los Angeles Times / December 5, 2013)

Snow came early to the cotton and sorghum fields here, sending dozens of cash-strapped families to the food bank on a recent afternoon for frozen chickens, cucumbers and canned green beans.

Quinetta Rascoe was waiting for them.

Wearing a bright pink overcoat, a glittery rainbow scarf and an infectious grin, Rascoe climbed out of a Toyota sedan carrying a stack of Obamacare brochures.

She eyed about 60 cars that were snaking into the parking lot behind Murfreesboro Baptist Church, prompting an unusual traffic jam one block off the town's dozy Main Street.

The food truck was late, and white plumes floated up from mufflers as the drivers switched their engines on and off and on again to warm themselves with blasts of heat.

"OK," Rascoe said, grabbing a pile of freshly printed business cards. "Let's go talk to people."

Rascoe is one of thousands of foot soldiers hired nationwide to sign Americans up for coverage under President Obama's Affordable Care Act.

Her task is made all the more challenging because she works in one of the Republican-led states openly hostile to the act. The GOP-controlled Legislature ordered state health officials not to cooperate with the federal program.

Many of the people in this rural swath of North Carolina — despite being among the neediest potential beneficiaries of Obamacare — remain skeptical and uninformed.

Walking up to the first vehicle, Rascoe smiled, shuffled on the balls of her feet and wiggled her fingers to get the perplexed driver of a dinged blue pickup to roll down the window. She explained she was there to answer questions about the Affordable Care Act.

The man mumbled a greeting, took the flier and quickly rolled up the window.

"Next car!" Rascoe said.

She felt lucky if she could persuade a driver to crack open the car window to take her card and a brochure. Some ignored her, a few listened politely.

"I just smile and give them the information; sometimes a light bulb goes off later and they call," Rascoe said.

One woman in a Chevy Bronco said she'd heard on the news that the website was down and no one could get enrolled. "Turn off the TV!" Rascoe chided. "Come down, and I'll help you out." The woman said she'd think about making an appointment.

Rascoe, 37, works most days in a small office at the Roanoke Chowan Community Health Center in nearby Ahoskie. The mouse for her desktop computer rests on a yellow foam pad stamped in red with the outline of a Trojan, the mascot for the University of Southern California, where she is taking online courses toward a master's degree in social work. A USC banner pinned to the wall reads: "Fight on."

When a person walks into her office, Rascoe asks questions to suss out whether the customer qualifies for the healthcare exchanges or for other federal programs like Medicare or Medicaid. She also tells the customer about a program at the health clinic that offers discounted rates based on a patient's income level.

At the moment, Rascoe's the only person at the clinic who is dedicated full time to signing people up for medical coverage. Local organizations across the state received a total of $7 million in federal grants to train and hire 300 Obamacare counselors.

But beyond a two-day online training course, a stack of government-issued brochures, business cards and a cellphone provided by the health center, Rascoe is largely on her own to come up with ways to find the uninsured.

It's a stark difference from other states that are trying to bolster enrollment by launching their own websites and ad campaigns and enlisting state employees to help people find insurance.