Nearly a half-million New Jerseyans stand to gain health insurance through the Affordable Care Act, unless they never hear about it.

That's become a pressing issue for health-care advocates who have expressed concern that the state, by opting for a federally run health-insurance exchange or marketplace, might end up with not enough money to reach the target audience.

They have expressed cautious optimism that outreach funding can be cobbled together from a variety of sources, including a $7.6 million federal grant the state was awarded to plan for a state-operated exchange.

The state applied for and won the exchange-planning grant before Gov. Christie decided to opt for a federally operated exchange. In rejecting a state-operated exchange, Christie cited the uncertainty involved, including how much it would cost and how much authority the state would have over it.

But that decision also reduced the state's potential for federal aid to advertise the exchange, an online marketplace through which residents will be able to compare and buy insurance and learn whether they are eligible for federal subsidies.

Raymond Castro, a member of the health-care advocacy coalition New Jersey for Health Care, said the state would benefit from using the $7.6 million for outreach.

"Obviously, we don't want to send the money back" to the feds, said Castro, senior policy analyst for the think tank New Jersey Policy Perspective. He has estimated, based on other states' outreach budgets, that New Jersey should spend $18 million to reach residents.

According to a report by the Rutgers University Center for State Health Policy, that amount would be similar to what was spent to reach residents in Massachusetts, the first state to launch health-care reform. Massachusetts spent $3 million on a campaign with the Boston Red Sox that targeted young men; another $3 million for a broader outreach effort; and $11.5 million for targeted, culturally appropriate outreach and enrollment assistance.

"We are clearly being shortchanged in the federal exchange, so the state has an opportunity to compensate for that in marketing and outreach," Castro said, noting that the federal government had set aside only $1.5 million for "navigators," nonprofit groups that will help targeted groups enroll through the exchange.

Marshall McKnight, a spokesman for the state Department of Banking and Insurance, said state officials were in talks with the federal Centers for Medicare and Medicaid Services about how the state can spend the $7.6 million grant.

McKnight would not elaborate on the discussions.

Another piece of the funding puzzle has fallen into place with $3.3 million of federal aid for the state's federally qualified health centers to enroll residents, through the exchange and through the expansion of Medicaid the Affordable Care Act calls for.

Katherine Grant-Davis, president and CEO of the New Jersey Primary Care Association, said the money would allow each of the state's 20 qualified health centers to hire at least one new full-time staff member to enroll residents. Larger centers could hire as many as six workers dedicated to enrollment, said Grant-Davis, whose organization includes all of the centers.

She said she hoped the outreach and marketing facets of the exchange were part of the state discussions with federal officials. She noted that a variety of techniques would be needed to inform some difficult-to-reach groups.

Potential statewide benefits from reducing the ranks of the uninsured are a good incentive for state officials to make outreach a priority, according to Evelyn Liebman, another member of New Jersey for Health Care and associate director of advocacy for AARP New Jersey. Those benefits include reducing the cost of charity care.

"We have hundreds of thousands of residents who could benefit from the exchange, but they need to know about it," she said.

Castro said that if the state government were willing to contribute some funding toward outreach, it might be able to reach his target.

"It's possible if the state does the right thing, we could wind up close to the $18 million," he said. "But the state would have to take action on this."

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