Magnolia Zarraga hadn’t had health coverage since graduating from Alisal High School in 1996. Between the lapse in coverage and her pre-existing conditions, she was quoted $900 per month for private insurance. “That wasn’t doable,” she says.
Last month, she enrolled in a subsidized “silver” plan for $230 per month through Covered California, the state’s health-care marketplace under the federal Affordable Care Act (ACA).
Although she found the process fairly easy, Zarraga, a Salinas-based immigration attorney, sees the need for more outreach to the Latino community, particularly those with language or accessibility barriers.
The ACA doesn’t offer coverage to undocumented immigrants, but it does cover legal permanent residents and people with certain visas. Zarraga says some of her clients worry applying for health care could affect their immigration status.
“Even though the government has made it very clear [their ACA application] won’t be used against them, it needs to be repeated that people don’t need to be afraid,” she says. “The word needs to get out to our population that this is the law, and that they can get free assistance.”
Just over a half million Californians signed up for health plans under the ACA from October through December, according to a Covered California press release. Another 1.2 million were routed into the state’s Medicaid welfare program, Medi-Cal.
But the enrollment figures show relatively low turnout among California’s biggest minority. The state estimates almost half of Californians eligible for government-subsidized premiums are Latino, compared with only one-fifth of December enrollees who qualify for financial assistance.
“There’s quite a bit of need in [the Latino] community, and there has been low participation in the Covered California program,” says Nancy Majewski, operations manager for Natividad Medical Center.
Covered California Executive Director Peter Lee says his agency’s working to close that gap. “We’re in the process of both fine-tuning the way we assess our enrollment demographics and, more importantly, building on our focus to ensure that more Latinos apply for and enroll in coverage,” Lee stated in the press release.
To that end, the Monterey County Department of Social Services is working with the county Health Department and Natividad. The work is part of a $500,000 tri-county grant including Santa Cruz and San Benito counties; the agencies are offering in-kind support to free up about $210,000 for Monterey County nonprofits and schools.
“We are not being funded,” says team member Margarita Zarraga, community affiliation manager for Social Services (and mother of attorney Magnolia Zarraga). “Our own resources are being invested because our director believes it’s the right thing to do.”
The outreach team is presenting at community forums, farmers markets, public libraries and schools, including an upcoming workshop targeting migrant parents of Salinas High students. Its educators are Covered California-certified and bilingual, and materials are provided in both Spanish and English.
The Monterey County Health Department and the Access to Care Coalition, a group of community-based organizations, are involved in a parallel effort funded by a $125,000 grant from the Blue Shield of California Foundation. The partners are focusing on underserved populations, including speakers of Spanish and indigenous languages, according to county Health and Policy Analyst Erica Padilla-Chavez.
Salinas Valley Memorial Healthcare System has reached out to Latinos with bilingual material, TV ads and face-to-face enrollment assistance. Bilingual-certified counselors are available 40 hours a week, including evening appointments. The bilingual material, meanwhile, is located in the hospital’s emergency room, front lobby and patient waiting areas.
“Our certified counselors can help people make sense of their insurance options,” says Pete Delgado, the system’s president and CEO. “Families can get face-to-face help from qualified professionals who know the ins and outs of the insurance exchange program.”
Natividad Medical Center is in the process of certifying eight Covered California enrollment counselors. “[We] are bilingual, biliterate and bicultural, so we are able to assist these families to get the coverage they need,” Health Education Assistant Enid Donato says.
County officials say community safety-net clinics are involved as well. Watsonville-based Salud Para la Gente is hosting health fairs and workshops encouraging people to enroll under the ACA. Officials at Clinica de Salud del Valle de Salinas, which largely serves Salinas Valley farm worker families, declined repeated requests for comment.
Although undocumented immigrants are ineligible for coverage through the exchange, their children might be able to receive full-scope Medi-Cal, Donato adds. And under the Medi-Cal expansion, even single childless adults might qualify for emergency Medi-Cal. “That was a really big breakthrough,” she says.
Ignacio Navarro, an assistant professor of public health at CSU Monterey Bay, last year coauthored a study for the Monterey County Health Department assessing the capacity of the local safety-net system and projecting health-care demand under the ACA. He found safety-net providers have expanded significantly over the past five years, but the county is still in need of more doctors.
About 90,000 county residents were uninsured last year, according to Navarro’s projections, and 46 percent of them were non-U.S. citizens. Among the county’s uninsured, about 55,000 should be eligible for Medi-Cal or subsidized private insurance under the ACA. But 26,000 more, many of them living in poverty, are ineligible due to their immigration status.
“It’s harder for them to access health care,” Navarro says. “For them, [the ACA] doesn’t make any difference.”
Navarro cautions the numbers from Covered California are too preliminary to paint a complete picture of enrollment among Latinos. “The ones who have access to information are going to be the ones who jump in first,” he says. “It’s going to take some time for the rest of them to see the benefits.”