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Wednesday, February 26, 2014

Why Are Latinos Lagging On Health Insurance Enrollment?

Vincent Dunbar (right) sits with his mother, Cicilia Reve, as he speaks with Josue Arevalo, an insurance agent with Sunshine Life and Health Advisors, as he shops for an insurance policy for his mother under the Affordable Care Act, Nov. 5, 2013 in Miami, Florida. (Joe Raedle/Getty Images)

Vincent Dunbar (right) sits with his mother, Cicilia Reve, as he speaks with Josue Arevalo, an insurance agent with Sunshine Life and Health Advisors, as he shops for an insurance policy for his mother under the Affordable Care Act, Nov. 5, 2013 in Miami, Florida. (Joe Raedle/Getty Images)

With only six weeks left before the March 31 deadline to enroll in health insurance under the Affordable Care Act, we check in on how signups are going — this time, in the Latino community.

In California, 1.7 million people have now enrolled through the state’s “Covered California” health exchange. But only 28 percent of those enrolled identify as Latino, even though Latinos make up 46 percent of the uninsured population.

Signup problems in California have included poor Spanish translation on the exchange website and a lack of Spanish-speaking employees at information hotlines. A Spanish language paper application wasn’t available until December.

U.S. Representative Loretta Sanchez, a Democrat from California, has been outspoken in her effort to enroll Latino residents.

Here & Now’s Jeremy Hobson checks in with her about California’s enrollment effort. He then turns to Univision producer Stephen Keppel for a sense of what is going on in the rest of the country.

Interview Highlights

Rep. Sanchez on the challenges of signing up Latinos for healthcare plans

“It’s just not a language issue, it’s also a cultural issue. You have to understand, for example, that Latinos are less likely to be on the Internet or have access to a computer, which means that even if they are, they go to the public library — you have a 30 minute time frame usually in which you can get onto the computer because there’s such a need, there’s a line for it. There’s no way that you could get on to Covered California and figure out what you needed for your family and be able to purchase and sign up for a plan within 30 minutes.”

“Remember we have mixed families in the Latino community, so somebody may not have the right paperwork or not be eligible for the ACA because they’ve been a legal resident less than five years, yet they might have children born here. Well, children need to be signed up. But children don’t go and sign themselves up. The person who either doesn’t have documents or who has been here less than five years, that’s in legal status, doesn’t want to jeopardize that for the ability to get citizenship by getting, quote, ‘a benefit’ from the United States. And so there’s a lot of education to be done.”

Stephen Keppel on Latino enrollment nationwide

“Actually, California is way out ahead of the rest of the country in this area. The congresswoman identified accurately a number of issues, with the outreach to Latinos and the enrollment of Latinos in California. But I think in other parts of the country, its probably even worse — especially those states that don’t have their own exchanges and haven’t expanded Medicaid… Texas and here in Florida, as well, the outreach has been even less, but we have huge populations of Latinos.”

Keppel on the reasons behind the low enrollment

“The government didn’t really think through how to launch or implement a law in two languages. I think, you know, this is the first time really that the government has had to think like that because this law impacts so many Latinos. About one in three Latinos don’t have insurance, so they have a lot to gain by this law. But I think it’s a lesson for governments going forward, if you’re going to implement something big, you’re going to have to do it now in English and in Spanish. Another factor is — especially recent immigrants, this idea of health insurance is different in some of their countries that they’re coming from in Latin America. It’s a very different system. So there is a lot of education and awareness that needs to be done.”

Guest

Transcript

JEREMY HOBSON, HOST:

It's HERE AND NOW, and there are now only 33 days to go until the open enrollment deadline to sign up for health insurance under the Affordable Care Act. That means if you're uninsured, you have 33 days to get insured, or you could be subject to a tax penalty.

Now we've all heard about the problems people have had signing up, but it turns out those problems are much worse for Latinos. In California, only 28 percent of eligible Latino residents have signed up under the state's exchange, even though Latinos make up 46 percent of the uninsured population there.

Congresswoman Loretta Sanchez is a Democrat from California. She's been out front pushing people to act on this issue, and she's with us now. Congresswoman, welcome.

REPRESENTATIVE LORETTA SANCHEZ: Thank you.

HOBSON: Well, what went wrong with getting Latinos signed up, and who's to blame for it?

SANCHEZ: Well, we identified the fact that almost half of Californians that did not have health insurance and were eligible to have would be Latinos. I identified that to Peter Lee, who of course is the executive director of Covered California, very early on. Unfortunately, that was kind of ignored. So now they're playing catch-up.

And that tends to be the case almost with everything with Latinos. People, you know, we try to tell them this is really the sweet spot, this is what we need to do, this is where we need to go, and people kind of don't really understand the demographics and the need there. But we...

HOBSON: Even in California they don't?

SANCHEZ: Even in California. It always amazes me how little attention is paid towards the Latino community in a lot of these broader outreach programs.

HOBSON: Now this is something that has been happening across the country to varying degrees, and we're going to hear more about that in a few minutes. But could the Obama administration have done more here? Obviously this is President Obama's signature piece of legislation. He has every interest in it succeeding. And if Latinos are such a big part of the success, should they have been doing more?

SANCHEZ: Well, I believe that we can all agree that the people who were implementing the Affordable Care Act from the federal side, given the fiasco in the beginning of the website, et cetera, really had their hands full and were somewhat overwhelmed, even though it was a three-year process. I mean, most of us are pretty angry about the rollout or the lack of a rollout.

And certainly even worse was the fact that if that - if they didn't do such a good job in English, imagine that they didn't do such a good job in Spanish. But it's just not a language issue, it's also a cultural issue. You have to understand, for example, that Latinos are less likely to be on the Internet or have access to a computer, which means that even if they are, they go to the public library.

You have a 30-minute time frame usually in which you can get onto the computer because there's such a need, there's a line for it. There's no way that you could get on to Covered California and figure out what you needed for your family and be able to purchase and sign up for a plan within 30 minutes.

HOBSON: Well, and we've heard about cultural issues having to do with signing up for something through the government because of their immigration status or maybe one of their relatives' immigration status.

SANCHEZ: Absolutely. Remember we have mixed families in the Latino community. So somebody may not have the right paperwork or not be eligible for the ACA because they've been a legal resident less than five years, yet they might have children born here.

Well, children need to be signed up. And so the whole - but children don't go and sign themselves up. The person who either doesn't have documents or who has been here less than five years, that's in legal status, doesn't want to jeopardize that for the ability to get citizenship by getting, quote, a benefit from the United States.

And so there - you know, there's a lot of education to be done in order to drive those people into the right place and get them to understand it's not about you, it's about your kids, and oh by the way, they must have a health care plan by the 31st of March.

HOBSON: Yeah, well, and so Peter Lee, who you mentioned, the head of Covered California, has promised $8.2 million to help sign up more Latinos. Is that going to work?

SANCHEZ: Well, you know, it's like anything else. You throw it at the last minute at the problem. It would've been much better if we could've had that money over the last six months to sign these people up, to get the information out, to saturate. Sometimes, you know, people don't get a message until they've heard it seven different ways. And to do it all at the very end is more in my opinion of like a scare tactic than it is to work through the community and understand what's happening and get people signed up. So we are working very hard to get this done.

HOBSON: Democratic Congresswoman Loretta Sanchez, joining us from Washington. Congresswoman, thanks so much.

SANCHEZ: Thank you.

HOBSON: Well, let's get the national picture on this now with Stephen Keppel. He's with Univision News in Doral, Florida. Stephen, welcome.

STEPHEN KEPPEL: Jeremy, great to be with you.

HOBSON: Well, so is this a California-specific issue, or is it happening across the rest of the country that Latinos are having a harder time, for whatever reason, signing up for health care?

KEPPEL: I think to be clear, we need to realize that actually, California is way out ahead of the rest of the country in this area. So the congresswoman identified accurately a number of issues with the outreach to Latinos and the enrollment of Latinos in California.

But I think in other parts of the country, it's probably even worse, especially those states that don't have their own exchanges and haven't expanded Medicaid.

HOBSON: We're talking about places like Texas.

KEPPEL: Yeah, Texas and here in Florida, as well. The outreach has been even less, but we have huge populations of Latinos. And if the state hasn't really promoted the law, and in many cases has actually kind of come out and fought against the law, there's just a lot of people that aren't getting the information.

HOBSON: Well, what are the problems exactly that are specific to the Latino community that everyone else is not facing as a burden to signing up for health care, in your view, in addition to what the congresswoman had to say?

KEPPEL: Sure, I think there are a few things. One, there's been issues with the rollout and the implementation. Everybody knows about the failures of the website. What they may not know is that the federal website wasn't translated into Spanish until maybe December or January. So they lost some valuable time there.

HOBSON: It launched in October.

KEPPEL: Yeah, the federal launched in October in English but not in Spanish. And I think as well, the government didn't really think through how to launch or implement a law in two languages. I mean, I think, you know, this is the first time really that the government has had to think like that because this law impacts so many Latinos.

You know, about one in three Latinos don't have insurance. So they have a lot to gain by this law. But I think, you know, it's a lesson for governments going forward, if you're going to implement something big, you know, you're going to have to do it now in English and in Spanish.

Another factor is especially recent immigrants, this idea of health insurance is different in some of their countries that they're coming from in Latin America. It's a very different system. So there is a lot of education and awareness that needs to be done. You know, that hasn't happened yet. And now there's like a big rush.

HOBSON: I'm imagining that yeah, at the deadline, you're not going to see every uninsured Latino-American signing up for health insurance. There are going to be a lot of people with tax penalties. How are they going to react to that? Who are they going to blame for the fact that they weren't able to do what they are required to do under the law?

KEPPEL: Yeah, that's going to be interesting to see. I do think we're going to see more people signing up before the deadline. But I think yeah, there's going to be, this first year, a lot of people that end up paying the fine. It remains to be seen who they're going to blame. But I mean, I think over the long run, people will, you know, will get the information they need and, you know, will figure out a way to sign up.

HOBSON: Stephen Keppel with Univision News, joining us from Doral, Florida. Stephen, thanks so much.

KEPPEL: It's been a pleasure, Jeremy.

HOBSON: Well, let us know if you have had any problems signing up for health care, whether you are Latino or not. Do you have questions still about the Affordable Care Act? You can go to our website, hereandnow.org. This is HERE AND NOW. Transcript provided by NPR, Copyright NPR.


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Robin and Jeremy

Robin Young and Jeremy Hobson host Here & Now, a live two-hour production of NPR and WBUR Boston.

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