Despite launching a Spanish language website, a bilingual call center and spending millions on outreach and marketing efforts targeting Latinos, the state of Illinois was unsuccessful in persuading the majority of these consumers to sign up for health insurance coverage in 2014, federal data show.
Only a little more than 1 in 20 Latinos in Illinois who were eligible to buy private health insurance under the Affordable Care Act did so in the first year, according to a Tribune analysis of enrollment figures released last week and federal Census data.
The lackluster participation numbers concern advocates, who question whether Latino consumers were targeted appropriately with federally funded, state-led outreach programs.
“If we really want to reach certain minorities, we have to become more culturally conscious and really think and refine how we talk to them and convince them that this is a product for them,” said Barbara Otto, CEO of Health & Disability Advocates, a Chicago-based health policy and patient advocacy group.
The enrollment report issued last week by the federal Department of Health and Human Services detailed for the first time the race of Americans who selected private health insurance plans under the health law.
Latinos historically have had the nation’s highest rate of uninsured, with 29 percent without coverage in 2012, according to Census data. That compares with about 17 percent of African-Americans, 15 percent of Asian-Americans and 10 percent of whites.
In Illinois, nearly half a million Latinos were eligible to gain coverage under the health law, including about 215,000 under the expansion of Medicaid and 278,160 who could purchase private insurance on the marketplace, according to an analysis of federal Census data conducted by Health & Disability Advocates.
Of those eligible to buy private insurance, only 15,691 Latinos had selected plans through April 19, according to the federal report, amounting to 5.6 percent of all those eligible.
“For all the money the state and feds spend reaching out to Hispanics in Illinois — with a separate website, Spanish-speaking navigators — we had a shockingly low participation rate among Hispanics,” said Naomi Lopez Bauman of the Illinois Policy Institute, a free-market group critical of the health law.
Jose Munoz, chief marketing officer for Get Covered Illinois, the state’s enrollment vehicle, said the state “did all the right things we should have done to reach this population. We took all of our best practices and implemented them across the state.”
He said the state is happy with enrollment, and noted that final racial data is incomplete because nearly a quarter of consumers who signed up for plans in Illinois did not specify their race.
“This is the first enrollment period, and the very first time that most (Latinos) have been exposed to the concept of insurance,” Munoz said. “I think you need to look at the complete picture before you draw conclusions.”
Many Latinos are expected to have gained coverage under an expansion of Medicaid in Illinois, but as of Friday, state officials could not provide racial data for the 287,000 Illinoisans who had enrolled. The state also has yet to process up to 200,000 additional applications.
Overall, 217,492 Illinoisans signed up for plans in the first year, about 24 percent of the roughly 909,000 eligible. Among other groups, 33 percent of eligible Asian-Americans, 27 percent of whites and 11.7 percent of African-Americans selected plans, the data show.
Only 7.2 percent of Illinoisans who selected plans on the marketplace reported their race as Latino. Whites comprised nearly 53 percent of sign-ups, while blacks accounted for 8 percent and Asians for 7.3 percent. Nearly one-quarter of Illinois enrollees, or 51,905, did not respond to the application’s question about race.
Nationwide, just 10.7 percent of those who chose plans on the federal exchange and reported their race were Latino, according to federal data.
Mayra Alvarez, associate director of the Office of Minority Health at the Department of Health and Human Services, said last week that the administration made “important first steps” to sign up Latinos, but acknowledged there is more work to do.
She cautioned that the demographic data is not complete, noting that it doesn’t include data from separate exchanges run by 14 states and the District of Columbia. Further, she said, 31 percent of enrollees did not report their race.
Advocates said they faced myriad challenges in attempting to urge Latinos to sign up for insurance, a concept and product with which many are not familiar. Latino families that had an undocumented member also were hesitant to enroll, fearing it could alert federal law enforcement or immigration officials.
Others have limited access to the Internet in their homes and operate in a cash-based economy, possibly dissuading them from purchasing a product that must be paid in advance, often over the phone or electronically, advocates said.
Another factor, Lopez Bauman said, is that the Hispanic population skews younger than the general population, meaning more of them are young and healthy and do not think they need health coverage.
David Elin, who oversaw the outreach effort for Enroll America in Illinois, said members of his team found that many Latinos categorized insurance as something they could not afford and therefore never looked into the option.
“Folks need to understand that financial help is available,” Elin said. “That’s something we really focused on in the last several weeks and something we’ll continue to focus on later this year.”
Otto said the state and advocacy groups need to better focus on the so-called working poor population who make too much to quality for Medicaid when open enrollment begins for 2015 in November.
“That’s the population that’s going to be harder to reach,” Otto said. “These are the people in the margins, and many of them are Hispanic.”
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