Like most taxi drivers, Sebti Boukarit doesn't have health insurance. And because he works up to 12 hours a day, six days a week, he hasn't had much time to sign up under the nation's new health care law.
But when he arrived at a Chicago city office to renew his taxi license one recent morning, the opportunity was impossible to miss. Enrollment workers had set up a table in the waiting room to snag drivers just like him, who are among the health law's most desired prospects.
"We have a captive audience," said Salvador Cerna, a coordinator for the Illinois outreach campaign, which gave enrollment information to 50 cab drivers and began the sign-up process for 18.
As the March 31 enrollment deadline creeps closer, time is running out for supporters of the law to make up for the months of technical problems that hampered the new insurance exchanges and depressed enrollment.
The latest figures show nearly 3.3 million Americans have signed up for private insurance plans on the insurance marketplaces, about a million short of where the Obama administration had hoped to be at this stage of the rollout.
In recent weeks, the sign-up effort has evolved from a dragnet strategy to a highly targeted approach focused on people most likely to be uninsured -- cab drivers, restaurant workers, artists, community college students -- and where they can be found. Cab drivers have particular health care needs because of the hazard of traffic accidents and the long hours they spend sitting.
Enroll America, a nonprofit involved in the enrollment campaign, targeted cab drivers in Philadelphia and Austin and plans to expand to other cities, hoping to reach a good portion of the 233,000 taxi and limo drivers in the U.S. The Chicago effort is chasing after the city's 12,000 drivers.
Hundreds of drivers have already enrolled in Philadelphia, said Ronald Blount, director of the Taxi Workers Alliance of Pennsylvania.
"Taxi drivers work one of the most dangerous jobs. They make very little money, and most of them don't have health insurance," Blount said. "This was an opportunity for them to get covered."
Meanwhile, the workers targeting students and artists have moved into churches, art centers and park district gyms.
During his encounter at the taxi office, Boukarit agreed to start the enrollment process.
"I have to talk to my wife and choose a plan," said Boukarit, 55, a native of Algeria who has lived in the United States for two decades and has driven a cab for 16 years. "I need insurance. I have treatment for my diabetes for almost 10 years. I need it to be covered."
Taxi companies don't provide health insurance. In Chicago, only about 30 percent of drivers have policies, according to one study. With average annual wages of $22,820 nationally, most would qualify for cost-lowering tax credits under the law. Others just starting out or working part time would qualify for Medicaid in states opting to expand the program.
Because drivers are prone to medical problems, health advocates are eager to get them covered and connected with primary care doctors rather than treated at higher cost in emergency rooms.
Taxi drivers have higher rates of injuries and illnesses compared with other occupations, according to the Bureau of Labor Statistics. Little U.S. research has been done, but a Japanese study of more than 5,000 drivers found they had more digestive disorders, sore backs and hemorrhoids than other workers.
One of those signed up in the waiting room recently was driver Mohammad Chaudri, who said he is eager to get plugged into the medical system, having once been part of it. A former emergency room physician in his native Pakistan, he is driving a cab part time while he prepares for a U.S. medical licensing exam. Chaudri, 32, signed up for coverage for himself and his 62-year-old mother.
"There is everything in this country, but the biggest problem is you don't have the proper information," Chaudri said. "You go to Google and there are 1,000 sites. It is very tough," he said, referring to finding and filling out a health insurance application without help.
Driver outreach in Chicago is considered so important it's "all hands on deck," with five community organizations helping, said Dr. Bechara Choucair, commissioner of the Chicago Department of Public Health.
"We started thinking we'd be here two days a week," he said. "Now we're here five days a week."
Taxi driver David Bilewu, a 39-year-old Nigerian immigrant, said he was initially thwarted by the technical problems with the HealthCare.gov website but now understands how to submit an application.
"It will give me the privilege of knowing I'm insured," Bilewu said.
Some immigrants face the challenge of assembling all the paperwork needed to prove legal residency of all their family members to receive the insurance. Almost all cab drivers do have the legal documents, though, because their jobs already require drivers' licenses.
In Philadelphia, "some drivers had to come three or four times to complete enrollment," Blount said. "But they did because this was so important to them."