Why Haven’t Latinos Signed Up?
It was sold as the long sought solution to the problems Latinos have in getting access to health care. But the implementation of the Affordable Care Act (ACA), or Obamacare, has been a lot bumpier than expected. In many states, Latinos will be the most likely to fall through the cracks of the new law aimed at providing nearly every American with health care.
“The enrollment has been less than optimal,” said Steven Lopez, senior health policy analyst for the National Council of La Raza (NCLR).
﷯But the NCLR, and most national Latino groups, are allied with the White House on the promotion of Obamacare and prefer to focus on its successes. “I would say it’s disappointing,” Lopez continued. “But I would say it’s on an upward trajectory.”
It is estimated that Latinos comprise 25% of all those eligible for Obamacare. Before the disastrous October 1 rollout of the Federal health exchange where the uninsured can shop for coverage, the Obama Administration planned to target Latinos in special enrollment drives, in large part because they are overrepresented in the ranks of the uninsured. According to the Kaiser Family Foundation, more than 10 million Latinos are uninsured, a third of all Americans without coverage. So focusing enrollment on Latinos, the White House thought, would help the administration reach a goal of covering 7 million uninsured by March 31. Because the Latino community skews young, signing up lots of Latinos would also give insurers what they most wanted---young, healthy people in their risk pools. Yet the Obama Administration has fallen short of its mark. Some problems were unexpected and unavoidable. Others weren’t. Websites in Spanglish
A major failing involved the Spanish language website,, which aims to help Spanish-dominant Latinos sign up. According to a survey by Latino Decisions, a political opinion research group, 63 percent of Latinos wanted ACA information in Spanish. But despite this, the website did not launch until early December, two months after the English language went live.
When it was finally functional, was widely ridiculed for containing grammatical and translation errors so severe that users described it as “Spanglish.” Some Latinos had to have “navigators” tasked to help enroll people translate the website for them. But there was also a shortage of bilingual “navigators.”
Elena Rios, president of the National Hispanic Medical Association and a strong supporter of ACA, said the Obama﷯ Administration decided to delay the launch of because of the horrific technical problems that plagued the English-language website. “The administration decided to fix the glitches of before putting up another website,” Rios said.
Richard Olague, a spokesman for the Centers for Medicare and Medicaid Services (CMS), the Federal agency leading the implementation of Obamacare, says the same thing. “We were mindful that launching both websites simultaneously may possibly have exacerbated the problems that were widely reported in October,” he said. “The soft launch approach we took allowed us to identify areas of concerns early and ensure the best product possible.”
Rios admitted “there was definitely a lag in reaching Spanish-dominant Hispanics. But she also said the two-month delay in setting up the website wasn’t fatal. That’s because younger Hispanics, who are more likely to be uninsured than older ones, were comfortable using the English-language website. And Spanish-dominant Hispanics aren’t as tech savvy as other Americans, preferring face-to-face enrollment with someone who can help them. Rios also said the time it takes to enroll for Obamacare online is a hurdle: “Most working Latino adults are too busy to go on a website that is going to put you on hold for an hour or so.”
To Rios, the problems Latinos faced in enrolling in health insurance is nothing new. “Hispanic enrollment in every single public program, even the school lunch program, is dismal,” she said. Losing Count of Latinos
Recently, the Obama Administration touted its success in enrolling 4 million Americans in health coverage. Yet, incredibly, no one knows how many of them are Hispanic. and are the portals used by 36 states who could not, or would not, set up their own websites. Other states, including California and New York, preferred to establish their own enrollment portals. Some of those portals do not have Spanish-language equivalents and others waited even longer than the Federal government set them up. Connecticut, for example, launched its Spanish-language website at the end of February, with just weeks left in the open enrollment period.
﷯The Federal government hasn’t kept track of how many states have bilingual exchange websites. Nor does it know how many Latinos have signed up for health care through a state or the Federal exchange. Olague of CMS said, “we don’t yet have reliable and complete data available to report on race and ethnicity at this time. ...While applicants may voluntarily report their race or ethnicity, neither applicants nor state-based marketplaces are required to report race and ethnicity. We will provide additional metrics when they are available and we expect to be able to provide additional data in the future.”
There is at least one state that does keep track of Hispanic enrollment and has done more than any other to reach out to Latinos: California. But even California is failing to meet its goals. In January, 28 percent of Californians who enrolled for coverage identified themselves as Latino, an improvement over the period from October through December, when it was just 18 percent. Still, more than 38 percent of the state’s population is Latino, representing more than one-half of California’s uninsured residents.
“We are not where we want to be,” said Lizelda Lopez, spokesperson for Covered California, the state’s health insurance exchange.
Covered California officials said they planned to spend $8.2 million in the weeks before March 31, the end of the enrollment period, on Spanish-language advertising. That’s a more than 70 percent increase in spending on these targeted ads over the first three months of the health insurance exchange’s operations.
One Spanish-language ad, called Tenemos un Plan (We Have a Plan), shows a father with his two young sons, kicking a soccer ball around and saying, “Por mucho tiempo mi familia estaba desprotegida. Y ahora no tengo miedo. Tenemos un plan.” (For a long time my family lacked coverage. But now I’m not worried. We have a plan.)
Covered California also said it hired more bilingual call center employees and sponsored more enrollment events in areas with high Latino populations, especially in those that are home to many low income Hispanics, including Los Angeles, the Inland Empire, the Central Valley and the San Joaquin Valley.
“We are well on our way,” Lopez said. Falling through the Gap
If California, which has a Democratic governor and has been given more money from the Federal government to promote enrollment than any other state is having trouble, it’s much worse in places where the political establishment has fought Obamacare. Those states include Texas and Florida, which like California are considered “gateway” states for Latinos.
A Supreme Court challenge to the ACA resulted in a 2012 decision that upheld the constitutionality of the most of the health care law, but determined that states could opt out the law’s provision that expanded Medicaid---a joint Federal-state health program for low-income Americans. That was an unexpected blow to White House efforts to maximize coverage of the uninsured.
This is why: Those lacking health care coverage can get it through the exchanges in two ways. They can buy private insurance offered in these market places, available in bronze, silver, gold and sometimes platinum policies that offer different levels of coverage. The more coverage and the lower the co-pays and deductibles, the higher the premiums. Purchasing even a bronze or silver insurance plan on the exchange can be expensive. But low- and moderate-income Americans, in households that earn $45,960 a year or less, are eligible for Federal tax breaks that can substantially reduce monthly premiums.
A second way shoppers on the exchanges receive coverage is that low-income applicants are directed to their state’s Medicaid program. The ACA allowed states to expand their programs so that single people and those with higher incomes would qualify for Medicaid. The Department of Health and Human Services determined nearly 8 in 10 uninsured Latinos may qualify for Medicaid, the Children’s Health Insurance Program (CHIP), or lower premiums through Obamacare. But some states refused to expand their Medicaid programs.
The failure of Texas and Florida to do so means up to 1 million Latinos just in those two states are falling through a “coverage gap.” Many Latinos would have been eligible for Medicaid if their state had chosen to expand coverage, but now are not. Those shut out of Medicaid are also unlikely to earn enough to qualify for premium tax credits which begin at 100 percent of the Federal poverty level. That means an individual must earn at least $11,670 to qualify for Federal help in purchasing a health insurance policy.
“We’ve gotten used to saying to people, ‘you don’t qualify for that program because you make too much money.’ Now we say ‘you don’t qualify for ACA because you make too little money,’” said Jose E. Camacho, executive director of the Texas Association of Community Health Centers.
Camacho said 73 percent of the patients seen in Texas’ community health clinics earn less than the federal poverty level. “Our experience is that 50 percent of the people we screen are not eligible for anything,” he said. “And most of the people we screen are working Texans.”
Camacho does not blame the ACA for “the sheer absurdity” of the situation. He blames Texas Gov. Rick Perry, a Republican, for failing to expand the Medicaid program. To make his point, the Texas Association of Community Health Centers web site,, has a running total of the millions of dollars the state is losing because it decided not to expand its Medicaid program. Under ACA, the cost of expansion is paid for fully by the Federal government for the first three years. After that, states must pay a share, but it’s usually minimal.
“Texas taxpayers are paying the 23 separate Obamacare taxes and they are getting nothing,” Camacho said.
The Kaiser Family Foundation has determined more than a fifth of people in the coverage gap reside in Texas. Sixteen percent live in Florida, eight percent in Georgia, seven percent live in North Carolina, and six percent live in Pennsylvania.
Latinos who are legal residents but not citizens face other problems. They are barred from enrolling in Medicaid, but given a break when it comes to Obamacare subsidies in that they don’t have a floor on their income to qualify for help. Besides the coverage gap, there are additional hurdles to Hispanic enrollment in states hostile to Obamacare. For example, Florida Gov. Rick Scott, citing “privacy concerns,” has barred anyone at county health centers from soliciting the uninsured.
“There are still very robust efforts going on in those states,” said the NCLR’s Steven Lopez. He said NCLR affiliates in Florida and Texas and other states “continued to do as much as they could” in the last few weeks of enrollment. “Latinos really value that one-on-one outreach.” Lopez also said Latino groups have also urged the White House to streamline enrollment forms for immigrants and work with Spanish-language media. But is it a case of too little, too late? Who’s Afraid of Obamacare? Another unexpected problem for the White House is the fear some Latinos have of the new law. Under ACA, undocumented immigrants are barred from seeking coverage through the exchanges. Yet according to the Pew Hispanic Center, about 9 million Latinos live in households that are mixed, composed of legal residents, U.S. citizens and undocumented members. ACA can help some of those family members get coverage, but that’s not always happening.
“There is this myth or rumor going around that if people fill out information on their health applications, that information will be used for immigration purposes,” Lopez said.
That’s preventing undocumented parents from signing up children who are U.S. citizens and scaring away other Latinos in similar situations. Samantha Artiga, director of the Disparities Policy Project at the Kaiser Family Foundation, also said some legal residents are staying clear of the health exchanges.“There’s been fears that enrolling in coverage would hurt their chances of getting a green card,” she said.
The situation alarmed the White House so much that Vice President Joe Biden held a teleconference with members of Hispanic organizations like NCLR and LULAC asking for help in dispelling the myths and misinformation. It also prompted Department of Homeland Security Secretary Jeh Johnson to broadly distribute a statement in Spanish that said Immigration and Customs Enforcement (ICE) has implemented a policy that prohibits the agency from using marketplace enrollment information for immigration purposes.
“Undocumented immigrants are not eligible to enroll in the health care marketplaces,” Johnson said. “Even so, I’ve heard that some people who live in the United States and are eligible to enroll in the marketplace are hesitant to do so because they fear the information will be shared with immigration officials and used to deport undocumented family members. That’s not true.” But ICE has little credibilty among Latinos, to say the least. And given the fact that the Obama Administration keeps deporting Latinos at a record pace, these fears seem justified. “It’s a very real barrier,” Daniel Zingale, vice president of the California Endowment, a Los Angeles nonprofit that promotes the law among Latinos, told HuffPost. “Families are worried about being deported and divided by having any official interaction with the government.”
Could some of these misconceptions have been dispelled through more timely and effective outreach? This problem is not unique to Latinos. In 2013, the Federal government awarded $67 million to over 100 organizations to hire and train “navigators,” but many states have placed restrictions on them, such as requiring a state license. Some organizations even returned the grants due to these complications. According to a Washington Post/ABC News poll last September, 62% of all Americans did not understand Obamacare. In February, the White House released a video in which President Obama urged Latinos to enroll and ask their “amigos, familia and vecinos” to do so as well. But Latinos are even less familiar with the intricacies of ACA than other groups. Only 49 percent were aware of their state exchange, compared to 68 percent of whites and 69 percent of blacks, according to a survey by the Commonwealth Fund. The Washington, DC-based National Alliance for Hispanic Health now gets 4,000 calls a month to its help line, according to Jane Delgado, the group’s president and CEO. Insurance companies stand to make a windfall from ACA due to millions of potential new customers, particularly among the young and uninsured, and many of them ramped up their marketing efforts as the March 31 deadline loomed. Yet few of these campaigns were directed at Latinos, either in English or Spanish. Nor did they adequately engage Hispanic media.
Just as this issue of LATINO went to press, President Obama made a final pitch to Latinos in a “historic” (according to the White House) Town Hall meeting at the Newseum in Washington, DC. It was hosted by the Asegúrate campaign, also known as “Get Covered,” a partnership between the California Endowment and Covered California, and was conducted entirely in Spanish with journalists Enrique Acevedo of Univision, and Jose Diaz Balart of Telemundo, with Obama gamely listening to a translation through an earpiece. Yet the discussion kept veering back to immigration. One woman asked if the information she provided would be used to deport her. “None of the information that is provided in order for you to obtain health insurance is in any way transferred to immigration services,” replied Obama.
But as more follow-up questions came, the president grew defensive. Pleading with Latinos to put aside his reputation as “Deporter in Chief,” he concluded: “The main point that I have for everybody watching right now is, you don’t punish me by not signing up for health care. You’re punishing yourself or your family if in fact there’s affordable health care to be had.”
So like Obamacare itself, many questions remained unanswered.
By Ana Radelat