Why Hispanics Didn’t Get Obamacare

The population’s uninsured rate declined, but the White House still has work to do to get the vast majority of Latinos covered.

National Journal
Clara Ritger
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Clara Ritger
May 1, 2014, 11:45 a.m.

Demo­crats still need to con­vince His­pan­ic voters that Obama­care is good for them.

Some 10.7 per­cent of health in­sur­ance ex­change ap­plic­ants were Latino, the Health and Hu­man Ser­vices De­part­ment an­nounced Thursday. This is the first time the Obama ad­min­is­tra­tion has re­leased ra­cial and eth­nic in­form­a­tion about the ex­change pop­u­la­tion, and be­cause ap­plic­ants wer­en’t re­quired to dis­close their race and eth­ni­city, the num­bers re­flect the roughly 70 per­cent who op­ted to re­port.

But the num­bers track well with oth­er sur­veys about the change in the un­in­sured rate among ra­cial and eth­nic minor­it­ies. Few­er than 11 per­cent of un­in­sured His­pan­ics got cov­er­age dur­ing the Af­ford­able Care Act’s open-en­roll­ment peri­od, ac­cord­ing to data from the most re­cent Gal­lup-Health­ways Well-Be­ing In­dex sur­vey. That’s com­pared with 16 per­cent gains for blacks, 17 per­cent for Asi­ans, and 14 per­cent for whites.

The num­ber mat­ters, be­cause His­pan­ics are the na­tion’s largest un­in­sured minor­ity, ac­count­ing for 25 per­cent of all un­in­sured in­di­vidu­als in the United States who are eli­gible for cov­er­age un­der the pres­id­ent’s health law. And al­though 10.7 per­cent of ex­change ap­plic­ants were Latino, there’s no in­dic­a­tion of how many were sign­ing up for health cov­er­age for the first time. By Gal­lup’s count, 37 per­cent of His­pan­ics re­main un­in­sured — and the next closest sub­group, blacks, are all the way down at 17.6 per­cent un­in­sured.

Why didn’t most of the 10.2 mil­lion un­in­sured Lati­nos eli­gible for cov­er­age buy health in­sur­ance this year?

In part, it’s be­cause the ad­min­is­tra­tion fumbled. It delayed the launch of Cuid­adoDe­Sa­lud.gov — the Span­ish-lan­guage en­roll­ment web­site — un­til Decem­ber, when it “soft launched” so that Latino groups work­ing with the ad­min­is­tra­tion could test and re­port bugs.

Then when the ad­min­is­tra­tion did pro­mote the web­site, users re­por­ted that the Span­ish was a messy trans­la­tion. Me­dia re­ports about the ac­cur­acy of the trans­la­tion were mixed, but suf­fice it to say that the Span­ish lan­guage has many re­gion­al dia­lects that were not all re­flec­ted in the words used on Cuid­adoDe­Sa­lud.gov, mak­ing it more dif­fi­cult for some nat­ive speak­ers to un­der­stand the health in­sur­ance ap­plic­a­tion pro­cess.

More im­port­antly, the ad­min­is­tra­tion delayed its out­reach to the Latino pop­u­la­tion.

“They wer­en’t able to get it right in terms of cam­paign­ing the policy,” said Gab­ri­el Sanc­hez, an as­so­ci­ate pro­fess­or and the in­ter­im ex­ec­ut­ive dir­ect­or of the Robert Wood John­son Found­a­tion’s Cen­ter for Health Policy at the Uni­versity of New Mex­ico. “If they would have done more of that early on in the pro­cess, that would have been more ef­fect­ive. That shows dir­ect in­vest­ment and en­gage­ment.”

The pres­id­ent’s ap­peal — a series of in­ter­views and town halls with Span­ish-lan­guage me­dia out­lets — came at the end of open en­roll­ment, when sign-ups were swell­ing across all ra­cial and eth­nic groups. Sanc­hez ar­gues it was one of the most ef­fect­ive tools the ad­min­is­tra­tion used, be­cause it showed that the White House was will­ing to court Lati­nos. He says the prob­lem was that it came too late.

The ad­min­is­tra­tion knows it has work to do in get­ting Lati­nos signed up for health in­sur­ance. It ac­know­ledged that fears of im­mig­ra­tion of­ficers us­ing His­pan­ics’ ap­plic­a­tion in­form­a­tion to track down un­law­ful res­id­ents lim­ited the num­ber of His­pan­ics sign­ing up on the ex­changes. Al­though un­doc­u­mented Lati­nos are not eli­gible for Obama­care, many Latino res­id­ents who are U.S. cit­izens ex­pressed con­cern for their un­doc­u­mented friends and re­l­at­ives. And His­pan­ics faced the same bar­ri­ers as oth­er ra­cial and eth­nic groups to get­ting cov­er­age, namely, not know­ing all that much about health in­sur­ance, its costs, and its cov­er­age be­ne­fits.

“Our goal re­mains to con­tin­ue to edu­cate and en­roll all Amer­ic­ans about the be­ne­fits and pro­tec­tions now avail­able to them be­cause of the Af­ford­able Care Act,” said Mayra Al­varez, as­so­ci­ate dir­ect­or of the HHS Of­fice of Minor­ity Health. “We will con­tin­ue to im­prove upon all of our out­reach and edu­ca­tion ef­forts, in­clud­ing ef­forts to the Latino com­munity. Our strengthened re­la­tion­ships with com­munity part­ners and Span­ish-lan­guage me­dia will help bet­ter pre­pare for us for the next open en­roll­ment peri­od and our shared goal of en­sur­ing every eli­gible Latino is en­rolled.”

The ad­min­is­tra­tion has plans to beef up com­munity part­ner­ships so that more His­pan­ics can talk to someone they know and trust about health in­sur­ance. And they’re go­ing to make tweaks to the Span­ish web­site to en­sure that Lati­nos have the best pos­sible on­line shop­ping ex­per­i­ence. This year they already had nu­mer­ous Span­ish-speak­ing nav­ig­at­ors, who served as in-per­son en­roll­ment help.

But per­haps the biggest obstacle is just get­ting His­pan­ics to like Obama­care.

Sanc­hez also polls His­pan­ic adults about the health care law for Latino De­cisions, a Latino polit­ic­al opin­ion re­search or­gan­iz­a­tion.

“Un­for­tu­nately, Lati­nos have con­sist­ently said they didn’t feel their voices were be­ing heard in the re­form,” Sanc­hez said. “For Lati­nos in par­tic­u­lar, the Span­ish-lan­guage tools not be­ing re­leased on time and then be­ing riddled with is­sues when they fi­nally did come out, that told them, ‘Look, they really didn’t care about our pop­u­la­tion get­ting signed up,’ and that may have dis­cour­aged them.”

The Pew Re­search Cen­ter tracked the un­fa­vor­able sen­ti­ment His­pan­ics hold to­ward the health law. Pri­or to open­ing of the in­sur­ance ex­changes — and be­fore word got out that Cuid­adoDe­Sa­lud.gov would be delayed — Pew found that Obama­care’s ap­prov­al rat­ings topped 61 per­cent among His­pan­ics.

By March 27, that num­ber fell to 47 per­cent — along with 47 per­cent of His­pan­ics who dis­ap­prove of the law.

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