Latinos, who just a year ago were highly sought customers for the Affordable Care Act’s marketplace plans may not get the same hard sell this year.
The Trump administration’s laissez-faire approach toward the upcoming enrollment period for the health law’s insurance marketplaces could reverse advances made in the number of Latinos with coverage, fear navigators and community activists.
Enrollment outreach efforts during the Obama administration targeted Latinos, both because they have a high uninsured rate and because a large proportion of the community is young and fairly healthy, criteria prized by insurers to help balance older, sicker customers, who are more likely to sign up.
Nearly a million people who identify themselves as Latino or Hispanic enrolled in marketplace plans this year, making up a tenth of customers. The uninsured rate among Latinos dropped from 43 percent in 2010 to under 25 percent in 2016. Still, millions are eligible and remain uninsured.
A shorter enrollment season and cutbacks in federal funding for marketing and navigator groups have the potential to allow Latino enrollment to slip, the advocates say.
California is one of about a dozen states that run their own marketplaces, and the state puts up its own money for marketing for Covered California. It will offer consumers a longer sign-up period than the federal government’s six-week window, with enrollment lasting through Jan. 31, the same as last year.
Latinos in California have seen a big gain in coverage since the implementation of the federal health law. The uninsured rate fell from 23 percent in 2013 to 12 percent in 2015, according to the California Health Care Foundation. (The foundation publishes California Healthline, an editorially independent news site produced by Kaiser Health News.)
Still, enrollment efforts in the state will be challenging if consumers don’t understand what is happening to the law as efforts continue in Washington to replace it, said Edgar Aguilar, program manager with Community Health Initiative, a network of grass-roots organizations in California that assist people signing up for insurance. He is in charge of the operation in Kern County, in the Central Valley, which has a high population of Latino farmers.
“We were successful signing up Latinos in the past. There are less than 8 percent of Latinos without insurance in the county, but the confusion about what is happening with Obamacare and the fear of deportation among immigrants make people think twice before renewing a health plan or [signing] up their kids for Medicaid or CHIP,” he said.
Enrollment for the 39 states using the federal website begins Nov. 1 and ends Dec. 15, about a month and a half less than in the previous year. Some states running their own exchanges have extended that period into January.
Claudia Maldonado, program director for the Keogh Health Connection in Phoenix, an organization that connects underserved people with health services, said uncertainty is what dominates these days. “We’re getting ready, because we know it’s going to be a difficult open enrollment period.”
The Spanish-language enrollment website, cuidadodesalud.gov, will be operating again this year, federal officials said, but it will face the same scheduled maintenance shutdowns as its Anglo sibling, healthcare.gov.
The Centers for Medicare & Medicaid Services (CMS), which manages the federal online insurance marketplaces, announced last month that the sites would be “closed for maintenance” for half the day on Sundays during the open enrollment period. The states that run their own marketplaces, such as California and New York, will not be affected by the shutdowns.
It’s unfortunate the service disruption of cuidadodesalud.gov will happen on Sundays, said Daniel Bouton, director of health services for the Community Council of Greater Dallas, a nonprofit that helps Latinos sign up for health care. “The day that Hispanic families go to church, where they are all together and where we have been enrolling them in previous years.”
“People want to have the issue of their health coverage resolved,” said Anne Packham, director of the insurance marketplace project at Covering Central Florida, an Orlando-based organization. “And all the announcements about Obamacare frustrate them.”
Enrolling a consumer on the exchanges is not a 10-minute process. A family can purchase a health plan there and also learn if they are eligible for Medicaid or CHIP, the federal-state insurance program for children in low-income families that earn too much to qualify for Medicaid. It can take up to an hour and a half and often requires more than one session with the navigator, who are the certified insurance market experts who have helped enroll millions of Latinos across the country.
Many Hispanics prefer to sign up for coverage in person with a trained navigator, said several people with experience helping consumers.
In an email, CMS said that scheduled website outages would not affect the enrollment flow and that the federal call center where consumers can get help with enrollment questions “will continue to assist callers.”
“It is important to note that the duration of the potential Sunday outages are the maximum amount of time allowed for the maintenance; actual outage times could be shorter,” the email added.
An Alternative Website
The Spanish-language website had a rough start when Obamacare plans launched in 2013, not coming online until two months after the English version. Still, navigators say that cuidadodesalud.gov often serves as a “last resort” for consumers, both Latinos and others, when they have technical problems with the English version.
“In past registrations, many times when healthcare.gov was down, the Spanish site was not,” said Bouton.
“Navigators are bilingual and generally use the site in English, but when it is not working well, they end the registration process in cuidadodesalud.gov, which often worked better [than healthcare.gov] in previous years,” said Julia Holloway, director of program development and navigator services for Affiliated Service Providers of Indiana, in Indianapolis. Her program has been told by federal officials that it will get 82 percent less money for navigators during the open season this fall.
The lower flow of consumers on cuidadodesalud.gov has made the Spanish version technologically more stable than the English version.
From Nov. 1, 2015, to Jan. 2, 2016, nearly 20 million people used healthcare.gov, compared with 953,708 who navigated cuidadodesalud.gov.
Fear Of Deportations
Navigators surveyed for this article said they feel more tension this year in the days leading up to the start of enrollment.
Hispanic members of Congress sent a letter to the Department of Health and Human Services in August seeking reassurance that enrollment outreach would continue for Latinos. A spokesperson for the caucus said an HHS representative promised to set up a meeting on the issue, but it never happened.
One hurdle to enrollment is the fear of deportations. Undocumented immigrants do not have the right to buy health insurance through the ACA markets, but there are thousands of families with mixed immigration status, and advocates fear they may be hesitant to buy insurance or apply for subsidies to help pay for coverage.
“Since the new government took office, when raids increased and the legal status of ‘Dreamers’ [young people brought to the U.S. while children] was in jeopardy, people started canceling their appointments with the navigators, and stopped enrolling their children in Medicaid or CHIP,” said Bouton.
However, navigators said they aren’t giving up. “We keep making calls. We have the same goal of registering more people,” said Maldonado. Her organization is operating with a 30 percent lower budget for navigators. In her state, Covered Arizona, a network of nonprofit organizations, continues to organize events, hand out leaflets and make calls to encourage enrollment.
“We had to cut the budget for marketing, but another organization that did not have that cut helps us and distributes our brochures,” said Bouton. More than ever, navigators say, the focus is on teamwork.
“We are passionate about what we do, and we will try to enroll as many people as possible,” said Holloway.