One quarter of Hispanics in the U.S. lack health insurance, the highest rate for any racial or ethnic group, according to census data. Reducing that number will be one of the Obama administration’s biggest challenges when it reopens health-insurance exchanges for a second year on Saturday.
During the first year’s sign-up period, just 2.6 million of an estimated 10.2 million uninsured Hispanics eligible for coverage enrolled in health plans, according to an October report by the Department of Health and Human Services. The Latino uninsured rate among those ages 18 to 64 declined 18%, but that was a smaller percentage decrease than for other groups.
“Providing insurance to 2.6 million is a huge accomplishment,” said Mayra Alvarez, director of the state exchange group at HHS. But “we have more work to do.”
The experience of Brígida Hernández illustrates the obstacles ahead. She completed her application for health insurance under the Affordable Care Act on the final day of enrollment during its first year. But she said she never heard back on what she was told would be a request for additional information, and she let the matter drop. Despite having diabetes and arthritis, she’s not sure she’ll try again.
“The monthly payment was high for me,” said Ms. Hernandez, 50 years old, as she sat in a waiting room recently at the Borinquen Health Care Center, a community clinic here.
Latinos and other Americans who lack insurance typically turn to community health centers that cater to the uninsured and emergency rooms, or they forego treatment altogether. Government funding and hospital charity care programs absorb those costs.
Numerous factors hampered sign-ups. The Spanish version of the federal health-insurance website, CuidadoDeSalud.gov, didn’t launch until December, and various glitches made it difficult to use. A shortage of Spanish-speaking enrollment aides, known as navigators, resulted in hourslong waits.
Uninsured Hispanics, who often knew little about copays, deductibles and provider networks, required more education than many advocates anticipated.
“It takes a heck of a lot longer to go through an application than any of us thought,” said Sinsi Hernández-Cancio, director of health equity at Families USA, an enrollment advocacy group.
Many Latinos legally qualified to secure coverage worried that applying would jeopardize family members who were in the country illegally, despite administration assurances that it wouldn’t. “The hostile atmosphere around immigration and deportations has had a chilling effect on enrollment,” said Daniel Zingale, senior vice president at the California Endowment, which invested in outreach efforts.
“It’s a real concern,” said the HHS’s Ms. Alvarez. “That’s why we are continuing to work to inform the Latino community that they do not need to be fearful to submit this information.”
A Pew Research Center survey in March found that support for the law dropped to 47% among Hispanics, down from 61% six months earlier. And the Obama administration said Monday it had instructed insurers to terminate 112,000 people’s plans because enrollees failed to provide additional documents to prove they were legal U.S. residents.
Enrollment for 2015 presents additional challenges. Enrollment groups will be advising those with existing coverage on how to renew or change plans while simultaneously luring new enrollees. Latinos “will probably need a wider range of assistance,” said Jodi Ray, project director at Florida Covering Kids & Families.
In response to complaints from consumers and advocacy groups, HHS made an array of fixes to CuidadoDeSalud.gov. It enabled the site to better handle hyphenated names and smoothed the identity-verification process, Ms. Alvarez said. It also ensured that half the navigators it is funding this round speak Spanish.
Outreach organizations have tweaked their approach with Hispanics as well. Enroll America, a national coalition of the law’s supporters, is emphasizing large-scale community events that entice families with food, music and free health screenings, said Jose Plaza, national director of Latino engagement. Those proved more effective in the first enrollment period than door-to-door canvassing and lecture-style presentations, he said.
Health insurers are taking a similar tack. “We’ll be doing a lot of face-to-face meetings,” in settings including community centers, markets and churches, said Alec Hoffman, sales manager at Blue Cross and Blue Shield of North Carolina.
In Florida’s Miami-Dade County—where 66% of the population is Hispanic and 33% is uninsured, the highest rate in the state—groups like the Epilepsy Foundation of Florida are training navigators and teaming up with hospitals and Spanish-language outlets to reach Latinos. The Borinquen clinic is hosting its annual health-care festival, which typically draws more than 2,000 people, a week into the new enrollment period.
Among those hoping to gain coverage this time around are Paulo and Ligia Coelho, who visited the clinic recently for a doctor’s appointment. If Mr. Coelho, 64, gets insurance, he said he plans to have a cataract removed from his eye. Mrs. Coelho, 60, is in good health, she said, but “you never know when there could be an emergency.”