With a March 31 deadline looming and the statewide rate of Latinos signing up for insurance under the new national health law falling below expectations, Orange County officials and nonprofit leaders have launched a push to encourage local residents to sign up.
“We’re all working together to get every community member who qualifies to get enrolled in a proper health insurance,” said Gloria Giraldo, a program manager for Latino Health Access or LHA during a news conference on Wednesday.
Open enrollment under the Affordable Care Act, also known as Obamacare, started at the beginning of October and runs until the end of March. It won’t start again until Nov. 15.
There’s also a Saturday deadline to sign up for coverage that starts March 1.
Across the state, the rate of enrollment among Latinos has been frustratingly low for officials. While Latinos account for 39 percent of California's population and about 60 percent of the state's uninsured, the New York Times reported Thursday that by the end of December, Latinos accounted for just 20 percent or less of those who had signed up through Covered California, the state's health insurance marketplace.
The poor start among Latinos is primarily the result of bad planning by Covered California, critics say. As the Times and others have reported, the exchange did not begin offering applications in Spanish until the end of December and the Spanish-language website was littered with translation errors for weeks after its start.
Another key problem is that the state did not employ enough counselors who are able provide the personal attention needed by many people who live in underserved communities and might never have had health insurance.
Reaching out to working-class neighborhoods presents unique challenges. For a variety of cultural and legal status reasons, many residents don’t react well to government workers coming to their doors.
Yet health advocates in Orange County said they're seeing some progress and point to recent numbers showing the county exceeding expectations. While officials expected to sign up 44,000 people by the end of January, more than 50,000 were enrolled at that point, said Adriana Moreno, a program director at the Children’s Health Initiative of Orange County.
A possible contributing factor is LHA's promotora program, a pioneering effort that for the past 20 years has employed promotoras or health promoters who walk door to door in Santa Ana and encourage people to become involved in programs that focus on a variety of health issues, including diabetes prevention, obesity, alcoholism, mental health, elder care and women's health.
A recent Field Poll indicates that as a whole, Californians support that approach, with at least 70 percent of voters saying they “considered community health worker services highly important in helping residents prevent and manage diabetes.”
Despite such indicators of support, however, the promotora program has come under fire in recent years from high-ranking county officials, include some members of the Orange County Board of Supervisors.
In 2011, Supervisors John Moorlach and Shawn Nelson took issue with the fact that promotora, a Spanish word, was being used to describe a county-funded program and hinted that the grant might not be approved. Nelson took issue with the word "Latino" in Latino Health Access, given that it serves a countywide population.
Then last year, county officials put forth a proposal that would have cut nearly in half LHA's funding from the county, about $1 million. In the end, most of the funding was restored.
Fast-forward to the present and officials are still struggling to bring Obamacare to some of those in local communities who need it most.
“These numbers definitely don’t represent the entire community” of eligible people, Moreno said, speaking of the enrollment figures that show Orange County ahead of schedule.
Health advocates said they’re trying to spread the word in as many ways as possible, including through medical providers, community clinics, local colleges and school districts.
They’re also holding health fairs at apartment complexes and working with community advocacy groups, such as Santa Ana Building Healthy Communities and Orange County Communities Organized for Responsible Development.
One of the main ideas behind the new health care law is that by bringing millions more people into the insurance system, overall health will increase and costs will drop.
“Now it can be used for when they need preventive care” to avoid having to go to the emergency room, Giraldo said.
The law includes an “individual mandate” that all Americans enroll in health care unless they qualify for an exemption. Fees would be levied on those who don’t sign up — at least $95 per person in 2014, $325 in 2015 and $695 in 2016.
The health care law also requires new minimum standards for private insurance.
Those standards include coverage of emergency services, hospitalization, maternity care, mental health care and laboratory services. And insurance companies now must cover pre-existing conditions.
People can choose from various private insurance plans that are publicly subsidized.
“Many of our families are people who work in jobs such as the service industry or on their own they clean houses, they do gardening, and before, [health insurance] was completely out of their reach,” Giraldo said.
Now there’s a “very concrete solution for those that qualify,” she added.
At Wednesday’s press conference, several people spoke about how the new health care law has made a positive impact on their lives and those they know.
Susan Lopez said her employer had provided good insurance that covered medical care for her son’s seizure disorder. But after she left that job, Lopez said private insurance was costing her almost $600 per month, just for her son.
When she checked the new health plans under Obamacare, Lopez said, “to my big, big surprise the insurance that we used to have, it was there, and now at an affordable price.”
“And his treating physician was even there.”
The law has also drawn criticism for mandating that people buy health insurance, major glitches with the national sign-up website, people being dropped from their current plans and sharp jumps in many premiums.
While the national website’s problems prevented people from signing up, Giraldo said Covered California’s site has been up and running from the very start.
Another major challenge facing the law is getting youth — particularly single young men — to enroll. These "young invincibles" are seen as critical to the law's success, since most insurance companies need healthy young adults to keep premiums low.
For a single, 26-year-old person making minimum wage, a bare-bones plan with high copays and deductibles costs as little as $1 per month, according to Covered California’s website.
For a family of four with $40,000 in annual income and moderate doctor and prescription usage, a “gold” rated plan can cost $162 per month or about $6,340 per year when including estimated out-of-pocket expenses.
That is, if one of the parents’ employers doesn’t already provide health coverage.
Undocumented immigrants, including students in the deferred action program, aren’t eligible for insurance under the health care law, but they do qualify for limited services under Medi-Cal.