Pajama Boy, "brosurance," and last month's "controversial" White House youth summit have all looked like ill-advised attempts at marketing the Affordable Care Act to young "invincibles," or people who think they're too healthy to need insurance. But instead of focusing so much energy on a demographic that can enroll but doesn't want to, it might pay off to go after a group that wants to enroll, but doesn't have the right tools. We're talking about people who primarily speak and understand Spanish. Hispanics, both English and Spanish speaking, make up 16 percent of the population and there are 10.2 million uninsured Hispanics who would qualify for coverage, according to The Wall Street Journal.
In addition to the same factors that prevent everyone else from signing up (like a broken website), there are three factors keeping uninsured Spanish speaking Americans from enrolling in health insurance: a lack of Spanish language resources, a lack of technological fluency and access, and a mistrust of the government. That's unfortunate because, as a Friday Kaiser Health News feature explains, Spanish speakers are a large, mostly untapped population of younger, healthier people, many of whom haven't been able to afford health insurance in the past.
CuidadoDeSalud.gov, or Healthcare.Gov in Spanish, wasn't fully functional until December, and training materials for Spanish speaking navigators and enrollment assistants weren't available until mid-November, according to The Wall Street Journal. CuidadoDeSalud.gov also still links to English-language pages in some places — you can't window shop for plans in Spanish yet. State exchanges, as usual, are sometimes better, sometimes worse. New York's exchange doesn't have a Spanish language site, but it has fact sheets and call center assistants for Spanish, Chinese, French, Haitian Creole, Italian, Korean and Russian speakers. Covered California has had a Spanish language website since October 1, but it also links to English at times and is only useful if you have a computer.
As Kaiser Health News found, often Spanish speakers — like part-time library aide Elizabeth Gonzalez of California — can't afford computers or smartphones, or rely on their children to translate English sites for them. Meanwhile, California's call centers are booked. "There’s no one picking up, probably because there’s not enough people," Gonzalez told Kaiser. "We need more information in poor communities and places to help you fill out forms so you know you’re doing it correctly. There’s not enough [information] in Spanish."
Of course, getting a website running and hiring more call center employees is a straightforward (if time-consuming) job. What's harder is the psychological aspect. Spanish speakers are worried about government's prying eyes and protecting their privacy, a concern detractors of the law have latched on to, somewhat justifiably. While administration officials have said no one has successfully hacked the site, there have been security holes to fix. For most of October, CuidadoDeSalud.gov had a security hole that would have given hackers access to personal information as a user typed, according to NextGov.
And while undocumented immigrants are not eligible for Obamacare, Kaiser notes that some individuals have undocumented relatives living in their homes, and worry that applying for insurance will lead to unwanted attention from the government and the potential deportation of their family members.
But if the administration can resolve those concerns they'd make a big dent in the number of uninsured — Hispanics are the most uninsured minority group, and would arguably benefit from the ACA more than anyone. Meanwhile, the difference between uninsured Spanish speakers and young invincibles is one of messaging versus outreach. Young invincibles think insurance isn't worth the money or effort, or are simply opposed to the law for other reasons. But they know how it works and have the resources to find coverage. They just choose not to pay for it.. But what Spanish speakers need is more outreach. They need Spanish-language resources and more Spanish-speaking navigators to gain their trust and help negotiate the tricky rules. That's a little more doable.