Most uninsured Latinos are eligible for tax credits or Medicaid, but insurers may need to rethink their outreach approaches, and absent federal immigration reform, states may have to help fill gaps for those who are both uninsured and undocumented.
About 10 million of the nation's 41 million pre-health reform uninsured population fall into the broad demographic of Latinos, and of those about 80 percent are eligible for insurance subsidies, Medicaid or CHIP, according to a new report from the Health and Human Services Department.
If all states expanded Medicaid eligibility, 95 percent of the nation's uninsured Latino's would be eligible for new coverage and coverage support, according to HHS. About 2.8 million of those Latinos live in California, 2.4 million in Texas, and 1.1 million in Florida.
About half a million live in Arizona and another half a million in New York, with the rest scattered across the country. More than 60 percent of those uninsured Latinos are estimated speak English as their first language or with great proficiency as a second language.
But convincing both English speaking and primarily Spanish speaking Latinos to buy a particular health plan or enroll in a government program may require establishing a personal relationship.
"The Latino community values the in-person connection from someone that they trust," said Steven Lopez, senior policy analyst at the National Council of La Raza, a Latino advocacy group. "That takes time to build trust."
The National Council of La Raza has affiliates doing consumer outreach and assistance for the ACA in 40 states, and Lopez said the "demand for this type of resource exceeds the supply," in some states more than others. In Texas and Florida, "it's not been hospitable to these types of efforts." And even in states like California, there's a great need for education, Lopez said, since Latinos who emigrated to the U.S. may come from countries with vastly different healthcare systems.
"You're asking someone to enroll in a plan and there's no relationship with that product," Lopez said. "This concept of an HMO is not something that folks outside of the U.S. healthcare system are that familiar with. They may be more familiar with going right to provider and paying them directly, or a broader structure with a government entity."
While HHS and advocacy groups see the ACA a boon for expanding access to healthcare for many uninsured Latinos, a large problem of healthcare inequality looms. Those estimated 11 million Latinos living in the U.S. without documentation are specifically barred from receiving tax credits or Medicaid; only their citizen or documented children are eligible.
With so much uncertainty remaining over the type of immigration reform policy that might or might not pass Congress, Lopez's group isn't offering any specific prescriptions for closing the coverage gap for undocumented communities. (Last year's Senate bill would offer new citizens benefits after 10 years.)
But he points to emerging policies in the states for potential solutions in the interim. In Washington State, for instance, the Apple Health Medicaid program for children bases eligibility only on income and not immigration status, meaning undocumented families can at least access pediatric care. In California, where about one million undocumented immigrants are estimated to be left out of ACA coverage, state Senator Ricardo Lara from Long Beach is trying to develop a bill that would extent either Medicaid or another safety net program to all residents, regardless of immigration status. So far, though, one month after his proposal, few specifics have emerged, perhaps because any such drastic change to Medicaid would run into significant federal hurdles.