Latinos, who just a year ago were highly sought customers for the Affordable Care Act’s marketplace plans, may not get the same hard sell this year.
The Trump administration’s laissez-faire approach toward the upcoming Obamacare enrollment period could reverse advances made in the number of Latinos covered, community activists fear. A shorter enrollment window and cutbacks in federal funding for marketing and navigator groups have the potential to cause Latino enrollment to slip, they say.
Enrollment outreach efforts during the Obama administration targeted Latinos, both because they have a high uninsured rate and a large proportion of the community is young and fairly healthy. These criteria are prized by insurers to help balance older, sicker customers.
Nearly a million people who identify themselves as Latino or Hispanic enrolled in marketplace plans this year, making up a tenth of customers. The uninsured rate among Latinos dropped from 43% in 2010 to less than 25% in 2016. Still, millions are eligible and remain uninsured.
Enrollment for the 39 states using the federal website began Wednesday and ends Dec. 15, about a month and a half less than in the previous year. Some states running their own exchanges have extended that period into January.
Claudia Maldonado, program director for the Keogh Health Connection in Phoenix, a group that connects underserved people with health services, said uncertainty is what dominates these days.
"We're getting ready, because we know it's going to be a difficult open enrollment period," she said.
The Spanish-language enrollment website, cuidadodesalud.gov, will operate again this year, federal officials said, but it will face the same scheduled maintenance shutdowns as its English-language sibling, healthcare.gov.
The Centers for Medicare & Medicaid Services, which manages the federal online insurance marketplaces, announced last month that the sites would be "closed for maintenance" for half the day on Sundays during the enrollment period. States that run their own marketplaces, such as California and New York, will not be affected by the shutdowns.
It's unfortunate that service disruptions will happen on Sundays — "the day that Hispanic families go to church, where they are all together and where we have been enrolling them in previous years," said Daniel Bouton, director of health services for the Community Council of Greater Dallas, a nonprofit that helps Latinos sign up for health care.
"People want to have the issue of their health coverage resolved," said Anne Packham, director of the insurance marketplace project at Covering Central Florida, an Orlando-based organization. "And all the announcements about Obamacare frustrate them."
Enrolling a consumer on the exchanges is not a ten minute process. It can take up to an hour and a half and often requires more than one session with a navigator, a certified insurance market expert.
In an email, CMS said that the federal call center where consumers get help with enrollment questions "will continue to assist callers." "It is important to note that the duration of the potential Sunday outages are the maximum amount of time allowed for the maintenance; actual outage times could be shorter," it added.
"Navigators are bilingual and generally use the site in English. But when it is not working well, they end the registration process in cuidadodesalud.gov, which often worked better [than healthcare.gov] in previous years," said Julia Holloway, director of program development and navigator services for Affiliated Service Providers of Indiana, in Indianapolis.
The lower flow of consumers on cuidadodesalud.gov has made the Spanish version technologically more stable than the English version. From Nov. 1, 2015 to Jan. 2, 2016, nearly 20 million people used healthcare.gov, compared with fewer than 954,000 who navigated cuidadodesalud.gov.
Hispanic members of Congress sent a letter to the Department of Health and Human Services in August seeking reassurance that enrollment outreach would continue for Latinos. A spokesperson for the caucus said an HHS representative promised to set up a meeting on the issue, but it never happened.
One hurdle to enrollment is the fear of deportations. Undocumented immigrants do not have the right to buy health insurance through the ACA markets, but there are thousands of families with mixed immigration status, and advocates fear they may be hesitant to buy insurance or apply for subsidies to help pay for coverage.
"Since the new government took office, when raids increased and the legal status of 'Dreamers' [young people brought to the U.S. while children] was in jeopardy, people started canceling their appointments with the navigators, and stopped enrolling their children in Medicaid or CHIP," Bouton said.
However, navigators said they aren't giving up.
"We keep making calls. We have the same goal of registering more people," Maldonado said.
Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.