“Even with the federal grants given out, it does not nearly cover the populations we have to reach and the amount of work we have to do,” says Lori Baptista, director of policy at the Tiburcio Vasquez Health Center in Hayward, Calif. The center sees 14,000 patients and clients each year; 78 percent are Latino and 70 percent do not speak English as a first language.
The ACA provides funding for “navigators” who are supposed to walk people through the enrollment process — which is likely to be akin to filling out a tax return in terms of complexity. Language barriers will add to that complexity for many eligible people.
Tiburcio Vasquez Health Center will be able to hire one full-time employee to work on enrolling patients in health coverage with the help of a federal grant specifically for federally qualified community health centers, but the center “could easily use 10 full-time navigators — that would be ideal,” Baptista says. Because California is running its own exchange, the center was able to get an additional grant from the state, but Baptista says it still didn’t come close to filling the need.
“This is a complex process, and it’s significantly more time-consuming to reach the Latino population,” many of whom have never had insurance before, says Baptista. “It requires a significant effort on the part of the navigator, the health center and the patients, especially those with limited English proficiency, to understand what opportunities are going to be available to them.”
The problem is even more severe for Hispanic community organizations that are not health centers and therefore do not have a dedicated source of federal funding, says Josephine Mercado, executive director of Hispanic Health Initiatives in Casselberry, Fla., a nonprofit that works on health education.
“We’re going to be getting the calls asking, ‘Where should I go, and which plan should I buy?’ The challenge is doing it without getting paid. We’re not going to be able to do it on an all-volunteer basis,” says Mercado. “They’re already calling us.”
Hispanic Health Initiatives teamed up with two other local Hispanic organizations to apply for an enrollment grant from the federal government to hire 40 community health workers to help Latinos sign up. But Florida will only be getting $5.8 million in grants to enroll the state’s 3.5 million uninsured residents, which Stan Dorn, senior fellow at the nonpartisan Urban Institute,calls “a drop in the bucket.”
The organizations have not yet learned whether they will be awarded the grant.
Tiburcio Vasquez Health Center and Hispanic Health Initiatives were both part of a survey of 135 Hispanic health clinics and community organizations in 23 states, released Thursday by the National Council of La Raza.
The survey asked respondents to describe their ACA outreach plans and identify challenges and barriers to enrollment. Those obstacles included lack of knowledge about coverage options and eligibility among patients and a lack of information from the state about plans, rules and regulations. A shortage of bilingual, bicultural staff trained in the enrollment process and insufficient funding for outreach efforts were also listed as important barriers.
“We have a lot of catching up to do,” says Manuela McDonough, a program manager at NCLR. “Community health centers and Hispanic community organizations are underfunded and understaffed and they can’t dedicate the time to do the necessary outreach to the most vulnerable populations.”
Without additional funding and culturally appropriate information, outreach efforts are unlikely to meet the needs of Hispanics, McDonough says, particularly because the While House’s “strategies and tactics for reaching Latinos is off.”
“They’re doing an online campaign, and a lot of the Latinos we serve don’t have access to online services,” she explains. The translation of the Obamacare Web site, www.cuidadodesalud.gov, is “not culturally competent,” she adds, and some of the videos are still in English.
And that makes the outreach efforts by local Hispanic organizations even more important. “The state and federal systems are likely to be complex, and a lot of them rely on online enrollment systems or call centers that may not have counselors who speak Spanish well,” says Jim Maxwell, director of research at JSI Research & Training Institute in Boston, which conducted the NCLR survey.
Even after health reform in Massachusetts, he adds, Hispanics were still the most likely to be uninsured. “And the success that did occur in Massachusetts was largely to do the role of Hispanic community based organizations and health centers.”
For its part, the Obama administration says it recognizes the important and challenging job of reaching out to Latinos.
“As one of the most disproportionately uninsured populations, Latinos are a key group to reach ahead of open enrollment in October," says Joanne Peters, a spokeswoman for the federal Department of Health and Human Services. "As we move forward, we will continue reaching out to diverse communities, including those Americans who speak Spanish or other languages to ensure they can take advantage of new and better health insurance choices.”
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.