HERNANDO, Mississippi When Dr Michael Minor first became pastor at Oak Hill Missionary Baptist Church in Hernando, Mississippi, in 1996, he discovered a population overcome by an epidemic of obesity.
"It was so bad, I was having a funeral every weekend," he said.
Minor took dramatic action for a Southern preacher, banning fried chicken at church potlucks and setting up a walking track around the church perimeter.
He has had marked success. "You can see the difference. People are much better sized, way better. And once they get it off, they want to keep it off," he said.
Now he is taking on the much bigger task of trying to get the state's nearly 275,000 uninsured people to sign up for health insurance coverage under the Affordable Care Act (ACA).
With technology problems dogging enrolment on Obamacare health insurance exchanges, the roles of people like Minor are becoming increasingly crucial in determining the success or failure of President Barack Obama's healthcare law.
His church is one of only two organizations in the state to get a federal "navigator" grant to help the state's uninsured sign up for policies provided through Obamacare.
He has his work cut out for him.
Mississippi ranked last in a 2012 study comparing the health of the states, tying with Louisiana, and consistently ranks at the top for rates of obesity and diabetes.
The local political environment has been far from friendly to Obamacare. Republican-led Mississippi rejected federal funds for an expansion of the Medicaid program for the poor - while its application for a state-based exchange was rejected by Washington, leaving it to use the faulty federal exchange.
"That man is essentially heading up outreach enrolment of the ACA for Mississippi. It's staggering," said Roy Mitchell, executive director of the Mississippi Health Advocacy Program.
Mitchell and other health advocates initially wondered just how this pastor of a tiny church on the Northwestern edge of the state won its grant.
"I applied for it," said the 48-year-old Harvard graduate and health advocate who grew up just miles away in the town of Coldwater.
"I'm a firm believer that people are limited because someone tells them they are limited," Minor said. "I tell my members we can do whatever we want to do. Let's just go for it."
'NO FRY ZONE'
In the foyer of Oak Hill Baptist hangs a picture of Minor and his wife, Lottie, in the White House, a proud reminder of the heights this tiny church of 100 or so has already reached under his leadership. His efforts caught the attention of First Lady Michelle Obama, who in 2009 invited Minor to help promote her "Let's Move" anti-obesity campaign and has invited him to the White House on several occasions.
Off to the side is a room housing a machine donated by the American Heart Association that allows parishioners to get regular readings of their blood pressure and body-mass index.
In the church kitchen hangs a plaque reminding the congregation that it is a "No Fry Zone," a sign of the church's commitment to offer healthier fare at church gatherings.
"It's a symbol, especially with people of colour," Minor said of the ban on fried chicken. "You've got to rally around symbols."
Seeing the success in his own congregation, Minor began expanding his gospel of healthy living. His church started sending teams of "health ambassadors" and health professionals to make regular checks on people in rural areas in the Mississippi delta, the poorest region in the poorest state in America.
He started organizing ushers in Northwest Mississippi to promote health among churches in the region, an effort that has grown into a national outreach program through the National Baptist Convention, the largest predominantly African-American Christian denomination in the United States.
Minor sees his work promoting health-care reform as a natural next step. "The ACA fits a niche," he said.
"The way we see it is, we're already doing a decent job with the spiritual aspect of it. The ACA affords us the opportunity to rescue the body and the mind."
As a navigator, Minor's initial plan was to recruit ministers in the 41 counties in the Mississippi delta, but when he realized that the other group with federal navigator funding, the University of Mississippi Medical Centre, was initially only planning to target current and past patients, Minor decided to set up a statewide network.
To stretch his $317,742 grant, Minor joined forces with Cover Mississippi, a network of consumer and patient advocacy groups and community health centres organised by the Mississippi Health Advocacy Program.
Building awareness will be critical. According to a Kaiser Health Tracking Poll released last month, two-thirds of the uninsured said they did not have enough information about the law to know how it will impact their families. And a survey commissioned by the MHAP of nearly 1,000 residents who would be eligible to buy insurance on the exchanges showed that three-fourths did not know enrolment began October 1.
The U.S. government has not released figures on how many people have signed up so far, but Chad Feldman, who's leading the navigator program at UMMC, said the centre has assisted more than 3,000 people, including 1,000 phone calls and more than 2,000 visits.
"The Mississippians we are interacting with are very interested. People are engaged and wanting to learn more," Feldman said.
The hospital has been reaching out to the 200 or so uninsured patients who seek treatment at the hospital each day, and early next year it plans to use its telemedicine network to offer video counselling to walk people through the application process in 100 sites across the state.
That would mean there would be no in-person navigators in some of the state's neediest counties.
So Minor has spent the past three weeks patching together a network of patient advocacy groups and church volunteers, who have gone through the needed 20 hours of navigator training, with the blessing of the Department of Health and Human Services.
He is also tapping into the network of some 20 community health centres and organizations that shared nearly $2.5 million in federal grants to become certified application counsellors - trained individuals stationed in health centres that can offer face-to-face enrolment assistance.
As of last week, Minor and his coalition partners had built a network of 75 to 100 navigators and counsellors.
"I was so happy I jumped up and down," he said. "We have navigators within an hour's drive of everywhere in the state."
The coalition crosses denominational lines and racial and ethnic lines. "People are just so excited," he said.
Minor's organization will be hitting its stride around the second week of November, when he expects to be signing up thousands of people for coverage that begins on January 1. The plan is to organize enrolment events ahead of the Thanksgiving and Christmas holidays in the hopes that people will share their good news during family gatherings.
"We feel like once you get people in churches and families, they will become de facto navigators," he said.
(Reporting by Julie Steenhuysen; Editing by Prudence Crowther)
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