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Obamacare challenge: Getting Hispanics to buy health insurance

Navigator Dianelys Dominguez, left, assists Giovanny Vega, 18, of Miami sign up for health insurance under the Affordable Care Act on Nov. 17 at the Borinquen Medical Center.
Published Dec. 1, 2014

WIMAUMA — Away from the Saturday morning din of the village center, where residents sorted through yard sales and considered taqueria menus, Azusena Mendiola had a tougher decision to make:

What to do about health insurance.

An uninsured mother of four who works in a packing plant, Mendiola had come to an enrollment event at this farming community's Good Samaritan Mission to get help signing up for coverage through the federal marketplace.

Mendiola, 30, struggled to explain in English why she had decided to apply. She turned to her 10-year-old son, Bryan, for help. "She says she thinks it's important in case of an emergency," he said.

The Obama administration, insurers and public health advocates are trying to encourage more Hispanics like Mendiola to sign up for coverage in this second year of the Affordable Care Act marketplaces.

For decades, Hispanics have had the highest uninsured rates of any racial or ethnic group in the United States. They are desirable consumers for insurers because they tend to be younger and healthier, though many are too poor to qualify for subsidies for private insurance and live in states, including Florida, that chose not to expand Medicaid eligibility.

U.S. Health and Human Services Secretary Sylvia Burwell told reporters last week that officials had made a number of improvements to help Hispanics, including changes that accommodate the hyphenated names common among Hispanics. She said the government also made it easier to access the websites through smartphones, which Hispanics — as well as younger people in general — are more likely to use for enrollment, instead of laptop or desktop computers.

Though there's no one-size approach to the diverse Hispanic community, experts say enrolling its lower-income and less-educated members has been a long battle against low expectations and distrust.

Felipe Korzenny, director of the Center for Hispanic Marketing Communication at Florida State University, noted that many Hispanics might be from families that never had insurance in their home countries, and they might not question that tradition.

In Mexico, where Korzenny grew up, people who are sick go to a pharmacy and get their medications directly, he said, rather than going to a physician for a prescription. "It's almost a different world view that has to be overcome," he said.

Trust is also a huge issue with Hispanics if they have relatives who are not documented.

Consumers who are legally entitled to shop on the marketplace — meaning they have all the proper documentation to be in this country — might fear that revealing certain information could put loved ones at risk of deportation, said Maria Pinzon, executive director of the Hispanic Services Council of Hillsborough County.

She said enrollment experts who understand that fear, even if it's not articulated, must assure them that authorities won't use their insurance application against their families. "A lot of work has to go into building that trust," Pinzon said.

People who cannot demonstrate they are here legally won't have access to the marketplace, the Obama administration has said. But some observers speculate that President Barack Obama's recently announced executive order on immigration could boost enrollment if Hispanics are less fearful for their undocumented relatives.

There are also practical obstacles to getting Hispanics signed up — and simply putting everything in Spanish isn't the complete answer. They might not know basic insurance lingo. And not all Hispanics use the same terminology, Pinzon noted. For instance, Spanish-speaking people from the Caribbean don't use the same word for health insurance as people from Mexico, she said.

"You have to make sure they know it's health insurance," she said, "not car insurance."

Advocacy groups are again trying to raise their profiles in Hispanic communities. The Hispanic Services Council's health insurance navigator, for instance, sets up shop at Hispanic churches and hair salons.

Many insurers are holding bilingual events to get an angle on the market. Florida Blue has a Spanish social media presence, advertises in Spanish-language media and hosts key events for the Hispanic community, such as Telemundo's Feria de la Familia festivals in Tampa and Orlando.

"In general, these tactics, and our important strategic relationships, have helped us to further establish our brand with the Latin community" Florida Blue spokesman Paul Kluding said.

It's unclear just how much all this effort in Florida can do for the poorest Hispanics. Although a study by the Commonwealth Fund, a foundation that focuses on health care, found the national Hispanic uninsured rate dropped from 36 percent to 23 percent in the first year of the marketplaces, that rate remained essentially unchanged in states, including Florida, that did not expand Medicaid eligibility.

Still, the population remains a heavy target — if not for private insurance, then possibly for county health plans for the poor. The event in Wimauma that Mendiola attended one recent Saturday tried to create a festive atmosphere with free popcorn, a DJ and a tented area where bilingual navigators from Suncoast Community Health Center had laptops to help residents enroll in coverage.

Mendiola and her mother-in-law talked with a navigator for a while but decided they didn't have time to go through the application that day. They left, but not before making an appointment to meet the navigator again, at a McDonald's.

Contact Jodie Tillman at jtillman@tampabay.com or (813) 226-3374. Follow @jtillmantimes.

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