Latino lawmakers and health leaders in California are sounding alarms about the state insurance marketplace's tactics for enrolling Spanish speakers and are urging changes after the recent announcement that fewer than 1,000 had signed up in the health law's first month.
"This is completely unacceptable," said state Sen. Norma Torres, a Democrat who represents parts of San Bernardino and eastern Los Angeles counties. "Obviously, their plan for reaching this demographic is not working. They should re-evaluate and come up with a new strategy."
The success of the California health exchange, known as Covered California, depends on the robust enrollment of Latinos, who make up about 60 percent of the state's uninsured population and are generally younger and healthier than other potential enrollees. The marketplace and nonprofit groups have poured millions of dollars into advertising and outreach aimed at Latinos.
Yet Spanish-speaking consumers made up just 3 percent of the state's 31,000 enrollees in October. Many more people were enrolling in November, according to Covered California, which has been largely free of the glitches plaguing its federally run counterpart. But a breakdown of that data by ethnic group isn't expected until the middle of December.
California's experience might bode ill for other heavily Latino states, where the barriers to Spanish-language consumers are even greater. On the federal website, there's no date for when the Spanish-language option will be working.
Advocates said several problems had contributed to California's lagging Latino enrollment: There's no paper application in Spanish for a population that often doesn't have access to computers or isn't comfortable using them. Not enough bilingual phone operators were hired to guide consumers through the online process. There's still a shortage of enrollment counselors, who can explain the process in person in clinics and other community settings.
State Sen. Ed Hernandez, a Los Angeles-area Democrat who's the chairman of the Senate Committee on Health, said Covered California needed to make a Spanish-language paper application available and to boost enrollment at community clinics and nonprofits.
"It needs to be ramped up very quickly," he said. "If it isn't addressed, it is going to be a huge issue."
Covered California's executive director, Peter Lee, said more enrollment counselors were being certified each week. At this point, more than 60 percent of the counselors speak Spanish, according to Covered California.
A call center with numerous bilingual operators recently opened in Fresno and a paper application in Spanish is scheduled to be available in mid-December.
"These are not ideal numbers, but we know the numbers will change," Covered California spokesman Santiago Lucero said.
Consumers may apply online through a Spanish-language version of the California website. But the site has had numerous problems, including asking security questions in English and misspelling Spanish words such as "si," said Daniel Zingale, a senior vice president at The California Endowment, a philanthropy that's invested heavily in Latino enrollment.
There also have been issues with the telephone system, which has guided Spanish speakers to English-language prompts, according to advocates and enrollers. And the average wait time to receive help is still about 18 minutes.
Ampelia Lopez, 50, said she desperately wanted insurance coverage so she could stop going to the emergency room every time she needed to see a doctor for her asthma. Lopez said she didn't have a computer so she'd tried to call Covered California. She waited for more than a half-hour before giving up.
"I am frustrated," she said. "It's like the DMV."
Spanish speakers often prefer the phone to a computer, and the system wasn't set up to accept all those calls, said Hector Flores, the chairman of the Latino advisory committee for the Los Angeles County Medical Association. "If there is a long line, that creates a barrier," he said.
In California, an estimated 1.7 million Latinos are eligible for Medi-Cal and 1.2 million are expected to be eligible for subsidies when they purchase insurance plans through the exchange.
Flores said most of his patients had seen Spanish-language advertising about the sign-up. But they have lots of questions and need to go to someone they trust for help, he said. Many of the enrollment counselors at those places – clinics, nonprofits and hospitals – are still waiting for final certification from Covered California.
Jose Rodriguez, an insurance agent in South Pasadena, was able to get his certification and has helped some Spanish speakers sign up for coverage. He guides them through an application in English, but there are other cultural barriers: Some of his clients are hesitant to turn over personal and financial information to the government. Others prefer to rely on home remedies rather than pay for insurance.
Throughout the state, some of those who are eligible are worried about calling attention to family members who are in the United States illegally and don't qualify for coverage. The potential applicants either don't know about or don't trust promises from immigration authorities that they won't use information from the health exchanges for deportations or other sanctions.
Aware of some of these challenges months ago, Covered California began running ads in Spanish and awarded outreach grants to organizations that work in heavily Latino communities. Officials also partnered with The California Endowment and Spanish-language media to educate Latino consumers, many of whom had never had insurance before.
But the recent numbers show that more resources may be needed, involving community health workers and outreach in neighborhoods. Raquel Donoso, the chief executive of the Latino Community Foundation, which funds programs for Latinos in the Bay Area and Central Valley, said there wasn't much time left.
Without adequately staffed call centers and a paper application in Spanish, Donoso said, it's not surprising that enrollment has been low. "It's definitely a problem," she said. "The state needs to take another look at what's the next step of the strategy."
Torres, the state senator, said the marketplace's ability to establish affordable insurance rates in the future might be in jeopardy if more Latinos didn't sign up. "You can't just buy up a bunch of Spanish-language advertisements and expect success," she said.
By Anna Gorman
Kaiser Health News