By Paula
Andalo October 30, 2017
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.
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.
In
Darkness
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.
Resources
Frequently
asked questions:
CMS
call center, available 24/7: 1-800-318-2596
“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
Edgar
Aguilar, program manager with Community Health Initiative,
a network of grass-roots organizations in California that assist people signing
up for insurance, said even though California does not face some of the same
challenges as states using the federal marketplace, enrollment this year will be
challenging.
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 immigration problems make people think
twice before renewing a health plan or [signing] up their kids for Medicaid or
CHIP”, he said.
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, Cover 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.
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