At the Mietphoum Khmer Spirit Center in the heart of Long Beach’s Cambodia Town, Vouchmeng Sieng is talking, as always, about health insurance. A small gathering of Cambodian American immigrants have trickled into the center on a bright Saturday afternoon to find out about the new, still mysterious, Affordable Care Act.

In rapid-fire Khmei, the patient care manager for The Children’s Clinic of Long Beach, spells out enrollment protocols under Covered California, doles out benefit information, and patiently answers questions from the multi-age, monolingual group.

“A lot of Cambodians don’t go to the doctor because they have no insurance and that’s why a lot of them will die young…they wait until the water gets to here,” she said, lifting her hand to her throat, “and then they start to swim.”

At one end of a table laden with vases of flowers, Naisimly Chhay pulls out a letter, written in English, that she just received from Covered California. Sieng translates and reads the letter aloud: Chhay has been deemed eligible to receive Medi-Cal. Chhay has lived in the U.S. for 15 years without health insurance, first because the sewing factory she worked for didn’t offer any and now because she is unemployed. When she had to have a lump removed from her cervix, she had a $10,000 medical bill, an out-of-pocket expense that she and her husband are still paying off.

“I’m very happy to have Vouchmeng help me to apply to the program because I was worried…I didn’t feel good,” said Chhay, who also suffers from thyroid and stomach problems. Looking at her 9-year-old daughter Monique sitting beside her, Chhy exhaled and said: “Now I feel safe.”

Since January, Sieng has helped enroll over 100 Cambodian residents of Long Beach like Chhy into a health plan tailored for their needs. Sieng and her colleagues at The Children’s Clinic have partnered with the Long Beach Health Department’s Medi-Cal and Healthy Families Outreach program, and United Cambodian Community to launch an aggressive signup campaign to boost enrollment by the March deadline. The coalition has held outreach events at temples and churches, canvassed neighborhoods, set up booths at community events, and are planning a push at the Cambodian New Year festivities in April.

Long Beach, known as the Cambodian capital of the U.S. with the second largest population of Cambodian immigrants outside of Southeast Asia, has approximately 20,000 residents of Cambodian descent, or 4 percent of the city’s population. As a group, Cambodian-Americans, have high rates of hypertension, diabetes, heart disease, stroke and seizures, according to a Stanford University report on the Health and Health Care of Asian-Americans. Cambodians are also at high risk for mental health problems and suffer from post-traumatic stress syndrome and depression, many having been affected by the genocide under the Khmer Rouge. Forty-five percent of Cambodians in a 2003 Connecticut health information survey self-reported that they had symptoms consistent with PTSD, according to the report Silent Trauma by the California Diabetes Program.

Roadblocks to Enrollment

Cambodians don’t always treat their illnesses because many work minimum wage jobs at companies that don’t offer medical insurance. The roadblocks to acquiring health insurance are often cultural, too. Many Cambodian-Americans don’t have the technological skills to use the Internet and many struggle to speak English. Covered California offers health care reform materials in the Khmei language, but the information is often technical and needs to be interpreted, said Susana Sngiem, the Program Developer at the United Cambodian Community.

Cambodian immigrants also tend to be wary of signing up for insurance because they worry enrolling would cause them to lose their Social Security Income, pay penalties, or get sued. “Cambodians are often disengaged or marginalized,” said Sngiem, “So our role is to be a bridge to the larger community of Long Beach, so they can get away from the survival mentality and thrive.”

Her organization has been effective at quashing those fears lately, having enrolled 50 people to Covered California in January. They have been using the fact that the mile-long business corridor of Cambodia Town is somewhat insular, to their advantage. When one family member successfully enrolls in Medi-Cal or another insurance plan, that’s community news. “We call it ‘Cambodian wifi,’” Sngiem said, “when they start to tell their friends and family, it catches on like wildfire.”

That is how Pho Morn, an employed but uninsured Cambodian resident, arrived at the cultural center to meet with Sieng from the Children’s Clinic that Saturday. Morn, who works part time at the 99 Cent Store, recently received a letter stating that he may likely qualify for Medi-Cal. Sieng has no doubt he will, given his limited income. Morn’s wife has hypertension and high cholesterol and will be relieved when they get their insurance card. “I know that everyone lives in this country needs to heave health insurance, otherwise when you end up in the hospital and pay a big amount,” he said.

Changing the Game

Anthony Ly, the health access outreach program coordinator at the Long Beach’s Health Department, said this hyper-local outreach campaign is emblematic of a larger, citywide push to reach all the uninsured residents of Long Beach, whether small business or self-employed or 18-to 30-year-olds who tend to not go to doctor until something hurts. At a recent enrollment event at Houghton Park, miles away from Cambodia Town, several certified enrollment counselors sit at tables with laptops. They patiently help Long Beach residents click through the Covered California website’s signup process.

The city’s Community Health Improvement Plan aims to bring the rate of uninsured residents down from 20 percent to 10 percent in ten years. “This is a game changer,” said Ly, “because this is the first time in history that we can actually put a dent in that.”