Why Latinos Don’t Care for Obamacare

Fears of deportation, language barriers, and confusion with the system’s sometimes byzantine regulations has caused Latino enrollment in the ACA to lag despite huge government efforts.

Norma and Rodolfo Santaolalla have always worked but have never had health insurance. When the Arlington, Va. couple tried to apply online for coverage under the health care law, it was just too confusing.

“I didn’t understand about the deductibles and how to choose a plan. It’s difficult. It’s the first time we’ve done that,” said Norma, 46, who cleans houses for a living. Rodolfo, 47, is a handyman. “That’s why we came here, to ask them to help us.”

“Here” was the Arlington Mill Community Center, where help was available on a recent Saturday as part of a national effort to increase Affordable Care Act enrollment, especially among Latinos.

Hispanics represent about a third of the nation’s uninsured, and for a number of reasons, signing them up has been harder. According to the latest government statistics (PDF), as of Jan. 16, two months into the current open enrollment period, just 10 percent of those who had enrolled in the 37 states served by are Latino, only slightly up from 7 percent during the first few months of last year’s enrollment, despite a concerted effort to reach them.

Experts caution that those numbers are reported by applicants and there’s no requirement that anyone signing up for coverage on state their race or ethnicity. Nonetheless, the Department of Health and Human Services and pro-health-law groups have stepped up their efforts through media campaigns and with a greater emphasis on the kind of in-person assistance the Santaolallas and many other Latinos are looking for.

In fact, nearly a third of the ACA’s media budget this year is focused on Hispanic media, tripling the 10 percent spent on reaching Latinos last year, according to HHS secretary Sylvia M. Burwell.

Providing in-person assistance, however, takes time. A session can easily run 90 minutes to two hours, and several meetings are often needed to explain how insurance works and what the various options are. Even though applicants may qualify for the law’s tax credits, many will have to still pay a premium each month. And people who have been doing without health insurance might not feel the need to pay for it.

Still, since October 2013, 2.6 million Latinos ages 18 to 64 gained insurance through the health law, according to HHS. As of last June, the percentage of Latinos without health insurance dropped from 36 percent to 23 percent, with the highest gains in states that adopted the health law’s Medicaid expansion, according to a Commonwealth Fund analysis. That’s important to the success of the overall health law, because uninsured Latinos tend to be young and healthy. They are likely to use fewer medical services and thus will help offset the cost of sicker people in the insurance “risk pool.”

To enroll, though, some Latino applicants confront extra paperwork and language barriers.

Joaquin Barahona, 41, is a construction worker. He’s never had health insurance, and when he did go to the doctor, he paid cash.

When he tried to enroll in the health law in late January, at the Legal Services of Northern Virginia office in Arlington, he found that the health law’s website couldn’t verify his identify. Now the Centreville, Va. resident will have to mail in additional documents, including his employment authorization card.

The same evening, Lusmila Morales, 53, also hoped to obtain ACA coverage. She sent in a paper application last year but never heard back and wanted to try again this year. She brought along her 17-year-old nephew to translate when she came to enroll in late January.

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The Falls Church resident is applying for health insurance “out of necessity,” said her nephew, Daniel Palacios. She has arthritis but can’t afford the medication. She needs a mammogram and a physical but can’t afford the tests. In addition, Morales’ mom has diabetes and she wants to find out how her parents -- who are both in their 80s and here legally but without the work history that would qualify them for Medicare --can get coverage under the health law.

But Morales couldn’t complete her application because she forgot her green card, which proves she is a lawful permanent resident of the United States. She would have to come back.

One of the most stubborn obstacles is the widespread fear in the Latino community that those who are eligible for coverage might endanger others in their family who are undocumented. That concern persists even though President Obama and other administration officials have said repeatedly that no information on a health law application will be used for deportation purposes.

“You don’t want to be the family member that because you signed up for coverage you’re getting your grandmother, your uncle or your parent deported,” said Anthony Wright, executive director of the group Health Access California, a healthcare consumer group.

The patchwork of state-based and federally based exchanges can also cause confusion, with some state governments more welcoming than others when it comes to Latino outreach and enrollment efforts.

Just over half of states have expanded their Medicaid programs, with Indiana the latest to make the change. According to HHS, if all states participated in the health law’s Medicaid expansion, 95 percent of uninsured Latinos might qualify for Medicaid, CHIP or tax credits to help lower the cost of health insurance on the federal and state marketplaces.

In states like Virginia, which has not expanded its Medicaid program, individuals must earn at least $11,670 a year to qualify for subsidies to buy coverage on the exchange. Those who earn less fall into the “coverage gap” because they don’t qualify for their state’s existing Medicaid program and don’t earn enough money to qualify for the health law’s financial assistance.

The fact that this year’s enrollment period is three months shorter than last year’s further complicates efforts to enroll the uninsured. And those who work with the Latino community say because so many in it have been uninsured for so long, it’s not surprising that it will take longer to reach them.

Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.