California has struggled to enroll Latinos in health insurance coverage through its new exchange, spurring waves of criticism from supporters of the law and potentially jeopardizing the program’s long-term success.
Of the 400,000 customers who responded to a question about their ethnicity, fewer than 20 percent identified as Latino, Hispanic or Spanish over three months of enrollment. Just 5.5 percent of customers, roughly 25,000 people, speak primarily Spanish, according to figures provided by the state exchange Tuesday.
Latinos, meanwhile, account for more than half of the state’s 7 million uninsured residents and about 46 percent of state residents eligible for government health care subsidies.
“The numbers just don’t add up,” said Rep. Loretta Sanchez, D-Santa Ana. “We cannot make health care insurance affordable and accessible for everyone without filling this void.”
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Sanchez and more than a dozen colleagues recently sent a letter to Covered California Executive Director Peter V. Lee urging him to do more to increase Latino sign-ups, including resolving a shortage of bilingual enrollment counselors in key areas of the state and fixing translation problems on the website.
“There are both obvious language barriers and less obvious cultural barriers that must be broken,” Sanchez told The Bee.
Latino enrollment is critical to the success of the health care law across the nation, and Lee said there are signs it will improve in California. New figures released Tuesday show that Latinos represented 30 percent of customers who filled out applications in the last three months of 2013 but didn’t select a plan.
“It means that we have a lot of people in the pipeline that we need to get through, and to get enrolled. And we are going to be doing that.” Lee said. “It also means, when you compare that to the about 46 percent who are subsidy-eligible, we still have work to do.”
State exchanges must enroll younger, healthier customers to maintain a diverse pool and hold down monthly premiums into the future. As detailed in Gov. Jerry Brown’s proposed budget, California’s Latino population is projected to soon become the state’s majority ethnicity.
Because California’s Latinos tend to be younger and healthier, their participation could significantly offset the cost of older, sicker residents, Sanchez said. Federal officials have said they need 40 percent of enrollees to be under age 35. California on Tuesday reported that 32 percent of its enrollees are in that age group.
Covered California officials have acknowledged stumbling in their outreach to Latinos.
The agency only recently unveiled a paper application in Spanish. Spokesman Santiago Lucero said he and Spanish-speaking colleagues have spent hours combing the website and online enrollment portal and fixing translation errors.
“Some was not translated at all and a few things were translated horribly,” Lucero said. For example, “male, originally written as ‘macho,’ was changed to “masculino.”
“We feel pretty happy about the changes we have made,” he said. “We will not stop until we see it completely perfect.”
Deeper cultural concerns continue to pose their own set of challenges. Those seeking to increase enrollment report that some potential applicants fear providing personal and financial information could risk the deportation of family members.
“Virtually all of our grantees engaged in enrolling Spanish speakers report back that the mistrust of government is an acute problem,” said Daniel Zingale, a senior vice president with the California Endowment. The group is spending tens of millions on outreach and enrollment.
For families with mixed-immigration status – commonly described as undocumented parents with documented children – “their fear of breaking up the family and deportation is real,” Zingale said. “What’s not real is the link between deportation and Obamacare.”
Immigration and Customs Enforcement has assured applicants for the new health care exchanges that their personal information is off limits for enforcement purposes. Zingale said the federal government should do more, including issuing a statement in Spanish attributed to President Barack Obama.
“They need to know there is a firewall,” he said.
California enrolled more than 500,000 residents and another 584,000 were determined eligible for Medi-Cal through year’s end. At least three-quarters of the exchange customers have paid their first month’s premium.
Another 125,000 customers enrolled in plans through Jan. 15. The figures appear to put the exchange well on the way to meeting its target of signing up 487,000 to 696,000 subsidy-eligible customers by the close of the first open-enrollment period March 31.
For all the early success, state Sen. Norma Torres, D-Pomona, said the numbers “mean nothing” when her constituents continue to voice concerns about sluggish phone and Web services.
As one of the first elected officials to sound the alarm about poor enrollment of Latinos, Torres urged the exchange to focus less on advertising and outreach and more on shoring up its own services.
The number of bilingual enrollment counselors remains too low, Torres said. She’s spoken with people who spent hours on the phone only to be disconnected. Others were alarmed to find that the information they submitted online went unsaved following repeated Web crashes.
“As much as we have pushed back to getting some adjustments made, we have only been able to accomplish one thing – ‘All circuits are busy’ – in Spanish,” she said. “That is tragic.”
Abby Arnold, project manager for a $1 million outreach and education grant to the Los Angeles County Federation of Labor, AFL-CIO, said the state failed to appreciate the needs of certain demographic groups.
“They did the planning from a Sacramento perspective,” said Arnold, part of a labor coalition working to educate largely Latino communities.
Many of the families researching their options are first-time buyers of health care. Others who get coverage through their jobs do so for only a portion of the year. Arnold said the group has discovered that primarily Spanish-speaking families want someone to guide them through the sign-up process.
“It’s often not clear what the benefits are to (a certain plan) unless you understand the insurance system,” she said.
In recent weeks, state officials have intensified their efforts to reach out to Latinos through television, radio and mail campaigns, incorporating the voices of trusted sources.
But while the amount of marketing and outreach could always improve, Allyson M. Saldana, an insurance broker based in San Mateo, said the level of enthusiasm for the program has proven difficult to handle.
“Even if Covered California’s team did a better job of marketing, I don’t think the system had the capacity to handle any more subscribers,” she said.
Exchange officials have said they are partnering with community groups that do a majority of their work with Spanish speakers to explain the system and facilitate enrollment. The agency also is working to steer more applicants to brick-and-mortar locations, such as county offices, for in-person assistance. It also has convened focus groups to learn more.
“(The numbers are) not where we want them to be. But we have seen an improvement,” Lucero said. “I think we will see a huge wave of enrollment in the Latino community and Spanish-speaking community in the last three months of open enrollment.”