‘Obamacare’ enrollment efforts should target Latinos, experts say

Despite the many hiccups of the first open-enrollment season of the Affordable Care Act — from a repeatedly crashing HealthCare.gov website to a Spanish-language version that kept people from enrolling — some 7.1 million people have so far managed to sign up for health insurance through the ACA’s marketplaces, a figured trumpeted as a success by Barack Obama’s administration.

In the last year, the number of uninsured people in the U.S. has decreased by 26 percent, according to the Department of Health and Human Services.

But 32 million Americans remain without health insurance, officials say, and nearly a quarter of them are Latinos. About 22 percent of Latinos — twice as many as non-Hispanic whites — are still uninsured, though that rate plummeted from 36 percent in 2013, before the ACA’s exchanges opened, according to a survey from the Commonwealth Fund that tracked enrollment before and after the first open-enrollment season.

While those are huge gains, experts say far more outreach needs to be done because Hispanics have historically been more likely to go without insurance.

“When you have a community where a third of the people didn’t have health insurance, the process of informing people about their options and the choices they need to make requires more time,” said Jane Delgado, CEO of the National Alliance for Hispanic Health.

She pointed out that health insurance is confusing to most people, even those who have had it for a long time. “It’s the nuances that make it complicated. It’s not like buying a television, where a TV’s a TV and there are some fine differences based on their choice,” she said. “These are matters of life and death.”

In addition some Hispanic people have expressed a belief that they don’t need health insurance, Delgado said.

For instance, in a 2013 survey by the Urban Institute, fewer than half the Hispanics polled disagreed with the statement “I’m healthy enough and I don’t really need health insurance,” compared with 64 percent of whites — implying that Hispanics were more likely to go without insurance.

“Our response to people is, ‘Can you afford not to have it?’” Delgado said.

One reason more Hispanics have hesitated to sign up for health insurance under the ACA may be due to a lack of awareness, despite the fact that eight out of every 10 uninsured Latinos qualifies for Medicaid, the Children’s Health Insurance Program (CHIP) or tax credits to help pay for insurance premiums on the ACA’s marketplaces, according to a 2014 HHS study.

When the exchanges opened last year, for example, CuidadoDeSalud.gov, the Spanish-language version of the federal health insurance exchanges website, was buggy and wasn’t immediately equipped for users to sign up online.

Additionally, there was a deficit of culturally specific outreach to Latinos, including not enough Spanish-speaking navigators to help Latinos, who tend to prefer signing up for insurance in person, according to Steven Lopez, manager for the health policy project at the National Council for La Raza.

“It wasn’t the most ideal implementation strategy in terms of their Latino campaign,” said Lopez of last year’s sign-up efforts.  But he was quick to add that the Obama administration has “made concerted efforts since the close of the first enrollment period to figure out where improvements need to be made,” including making sure more in-person assistance is available to help people sign up and that those staffers are culturally and linguistically trained to help Latinos.

Both La Raza and the National Alliance say they are partnering with Spanish-language broadcasters such as Univision on PSAs and with community-based organizations across the country to help with enrollment.

In California, which ran its own insurance exchange, Covered California made a concerted push to enroll Latinos from the state’s vast Spanish-speaking population during the final month of the first open-enrollment period. And it paid off — Hispanics ultimately accounted for 28 percent of the 3 million total enrollees. This year the state has invested in an increased presence of in-person assistance, perhaps in a nod to the Latino population.

But in other states that have resisted the ACA, the more difficult barrier in both enrollment seasons has been Medicaid expansion — or rather, the lack of it. In the 21 states that have decided not to accept federal funding to expand Medicaid, low-income uninsured people who would have been newly Medicaid-eligible under the government’s expanded rules are out of luck.

Texas and Florida, for example, have vehemently opposed the ACA and opted not to accept federal funding for Medicaid expansion, shutting out nearly a million low-income Latinos from Medicaid coverage, according to Lopez.

That has left community-based organizations, hospitals, health care advocates and local government officials to shoulder much of the burden of outreach and enrollment efforts, he said.

“It’s unfortunate that some of these states with the highest number of uninsured individuals didn’t take the opportunity to invest the funds back into the health of their residents,” Lopez said in reference to those states that opted not to expand Medicaid.

Immigration status has been another barrier. Many Hispanics from mixed-immigration-status families they worry that by signing up for insurance they will expose family members to deportation. And parents with children who were born in the U.S. may be reluctant to sign their children up for coverage because of their own undocumented status.

While Immigrations and Customs Enforcement (ICE) clarified in 2013 that people signing up for health insurance under the ACA would not be targeted for their relatives’ immigration status, there is still a lot of fear, Delgado said.

Delgado also worries about young immigrants who have been granted work authorization and a renewable two-year deferral on deportation through DACA, Deferred Action for Childhood Arrivals. The health care law says that all immigrants considered “lawfully present” in the U.S. are eligible to sign up for insurance under the ACA, but the administration clarified in 2012 that DACA immigrants are not included.

“Which doesn’t make sense,” said Delgado. “You want those young, healthy people to buy insurance. The more people who buy insurance, the more it saves everyone else.”