For millions of Hispanics, the federal government’s botched rollout of the Patient Protection and Affordable Care Act has jeopardized access to health care. As HealthCare.gov and its Spanish equivalent CuidadoDeSalud.gov have faltered, local organizations have taken on the burden of increasing awareness and helping facilitate registration among uninsured Hispanic Americans.
HealthCare.gov was launched at the beginning of October to facilitate individual registration for health care under the Affordable Care Act. Numerous website glitches have plagued the rollout of the site.
During October, about 27,000 individuals were able to sign up in the 36 states dependent on HealthCare.gov for registration. In contrast, the District of Columbia and the 14 states with state-run exchanges saw 79,000 individuals sign up for coverage, according to the Obama administration. The total of roughly 106,000 fell well short of the White House’s publicized first month goal of 500,000.
Things are no better for the site’s Spanish-language counterpart, CuidadoDeSalud.gov, whose situation is far worse. The site does not yet include an online application, and only directs individuals to call a customer service representative. Along with a phone number to call, the site features the message “La solicitud en línea estará disponible pronto,” which roughly translates to “The online application will be available soon.”
A customer service representative at this number was unable to give an estimate for when the site may feature an online application.
With governmental hiccups at the national level, local organizations and national advocacy groups have led the charge to promote enrollment among the nation’s 10.2 million uninsured Latinos, seeking to overturn a generations-long dearth of health insurance among the population.
In many cases, local efforts to increase digital literacy and provide basic computer skills have played a major role in both raising awareness of the health care marketplace and assisting individuals in underserved areas with registration.
One such example is the Smart Communities program. A part of the City of Chicago’s Digital Excellence Initiative funded by a federal grant under the “American Recovery and Reinvestment Act,” the program worked in five underserved neighborhoods—Auburn Gresham, Chicago Lawn, Englewood, Humboldt Park and Pilsen.
Among other services, the program provided Spanish and English digital literacy resources that contributed to a 15 percentage point increase in Internet use compared with similar Chicago communities, adjusted to account for gentrification in certain areas. According to Program Officer Dionne Baux, Smart Communities has provided approximately 4,000 individuals with information regarding enrollment in the Health Care Marketplace.
“They can come into sites that have computer labs and have basic training needed not only to access the site but also to fill out applications,” Baux said.
Still, it will be hard for local organizations alone to effectively assist the country’s vast and growing Hispanic population.
The U.S. population includes more than 50 million Hispanics, who make up nearly 17 percent of the nation’s population and represent the fastest growing ethnic or racial group, according to the U.S. Census Bureau.
Despite making up under one-fifth of the country’s population, Hispanics account for just under a third of the country’s uninsured population under 65 years old, according to a study by The Henry J. Kaiser Family Foundation.
The state of Illinois has more than 2 million Hispanic residents, the fifth largest Latino population of any state in the country, approximately 800,000 of whom live in Chicago. Twenty-six percent of Illinois’ Hispanic residents are uninsured, according to a 2011 Pew Research Center report. In Illinois, 19 percent of blacks and just 8 percent of whites were uninsured.
More frightening was the rate among foreign-born Hispanics, 46 percent of whom were without insurance, according to the study. These individuals would figure to be among the most adversely affected by the shortcomings of the Spanish-language registration site.
One in six Hispanic children nationally are without health insurance, according to a publication by Hispanic advocacy group National Council of La Raza. Studies have connected lack of health insurance during childhood to higher rates of hospitalization, missed immunizations and checkups, damaging asthma outcomes and missed days of school, among other negative consequences.
“The trajectory of your health in life is very much set during childhood,” said Carol Berkowitz, executive vice chair in the Department of Pediatrics at Harbor-UCLA Medical Center. “A lot of illnesses that affect adults have their onset in childhood.”
The ultimate success or failure of implementation of the Affordable Care Act will likely have a major impact on the U.S. political climate in the coming years, according to some experts
President Barack Obama had a 44 percent approval and 50 percent disapproval when HealthCare.gov was launched at the start of October, but sat at 40 percent approval with 53 percent disapproval on Nov. 18, plus or minus 3 percentage points, according to Gallup polls. These plunging numbers and widespread discontent with the rollout have forced some modifications to the implementation of the Affordable Care Act.
The enrollment period for the new health care marketplace was set to end Feb. 15 but problems with HealthCare.gov led to an extension of the enrollment period until March 31. Obama also announced recently that 4.8 million individuals, whose health plans were to be terminated by insurers because they did not meet new standards under the Affordable Care Act, will be able to renew their old coverage for one more year.
“The rollout has been rough so far,” Obama said during a Nov. 14 news conference. “The problems of the website have prevented too many Americans from completing the enrollment process, and that’s on us, not on them.”
Research has indicated the effects of the Spanish website’s shortcomings may be mitigated some by Hispanic preferences, according to the Centers for Medicare & Medicaid Services, or CMS, which covers more than 100 million individuals through Medicare, Medicaid, the Children’s Health Insurance Program and the marketplace established under the Affordable Care Act.
The agency’s market research suggested 70 percent of Hispanics would register in English, alleviating some need for an online Spanish application, but still leaving 3 million who would prefer to register in Spanish. It also found a preference among Hispanics for personal assistance, like that available through call centers, which had received over 65,000 Spanish language calls as of mid-November.
“Consumers who would like to enroll in health insurance in Spanish today are encouraged to use the Spanish-language enrollment options that are already available,” a CMS spokesman said in an email. “Additional features for online enrollment will be available as we make upgrades to the site.”
Despite still missing an online application option, CiudadoDeSalud.gov provides alternative resources to assist Hispanics seeking to register through the site. The site offers access to call centers and live Spanish web chats for assistance, as well as a paper application form in Spanish.
Coverage under the Affordable Care Act will begin Jan. 1, 2014 and individuals are required to have coverage by March 31. Those who fail to acquire coverage before the March 31 deadline will face fines and will not be eligible to enroll again until next October.