Enrolling Hispanics In Health Insurance: Lessons Learned And Policy Recommendations

Wednesday, October 14, 2015


BOSTON - Researchers, public officials, community members and organizations gathered today at the State House to mark Hispanic Heritage Month with a discussion about new research and best practices for reaching and enrolling the Commonwealth's uninsured Hispanic population.

The study, which surveyed more than 3,200 Latinos in Massachusetts, found that 52% had never had insurance despite almost 10 years of health reform in the state.

"Although progress has been made in covering Latino residents since Massachusetts' landmark 2006 health insurance law, disparities persist," said Jim Maxwell, Research and Policy Director at JSI Research and Training Institute, Inc., adding, "Latinos are one of the largest groups of remaining uninsured in the state. They are more than three times as likely to be uninsured as whites, with whites having uninsured rates of 3.9% compared to 10.3% for Latinos. Those with low English proficiency have even higher rates of uninsurance, at 15.8%."

JSI Research & Training Institute, Health Care For All (HCFA), and the Institute on Urban Health Research and Practice at Northeastern University conducted quantitative and qualitative research to understand which barriers Latinos in the state face to getting covered and to staying covered.

"Our survey found that there is a large group of Latinos who have remained uninsured since the start of Massachusetts Health Care Reform Law (Chapter 58), even though many have sought to obtain coverage. Other groups of Latinos suffer from frequent gaps or lapses in their coverage," said Dharma Cortes, Associate Professor Adjunct at the Institute on Urban Health Research and Practice at Northeastern University.

As part of this effort, consumers answered questions about their health coverage -- if they were insured or uninsured and for how long -- and about access to primary care and problems with medical debt. Researchers employed a two-stage survey, consisting of a screener of 3,216 non-elderly adult Latino residents, followed by 1,527 in-depth surveys with Latinos. Of the 3,216 Latinos screened, 38% were currently uninsured (11% never had insurance as an adult, 27% were currently uninsured but had insurance previously).

Once the information was gathered and interviews with key experts were completed, a list of best practices was compiled in order to promote effective enrollment of Latinos, as well as policy recommendations aimed at improving efficiencies and reducing churn among those populations.

The importance of identifying the community where Latinos live and work; mapping specific Hispanic sub-communities (Puerto Ricans, Mexicans, Brazilians, etc.); and engaging those consumers through ethnic media or/and utilizing community leaders were some of the lessons learned in outreach and education. Creating a culture of coverage with messages that resonate, emphasizing "It's the law" to have health insurance, and addressing any misinformation about immigration status and health coverage will also be important to keeping Latinos insured.

In terms of enrollment, it is important to plan for a multi-step process -- the work is not done once a person is enrolled in health insurance -- as everyone needs to renew annually, and they have to know how to use their insurance card. Bilingual and culturally knowledgeable counselors and one-on-one assistance are the best tools to keep Hispanics connected to coverage.

"We hope that the lessons of this study will accelerate the aggressive pursuit of state and national efforts to enroll Hispanics in health coverage under the Affordable Care Act," commented Dr. Rodolfo R. Vega, co-author of the study and Senior Consultant at JSI Research and Training Institute, Inc.

"State agencies have made concerted efforts to expand coverage to Latinos, but the state needs a single official-a czar-to be responsible for addressing Latino coverage issues. Grassroots outreach and enrollment strategies are critical to covering Latinos, but consistent state funding is needed to support the organizations doing this work," expressed Brian Rosman, Research Director at Health Care For All.

Jeffrey Sánchez, Chairman of the Joint Committee on Health Care Financing, hosted the event at the State House and said: "These results are going to have a major impact on how we enroll Hispanics in healthcare coverage. Ten percent of Hispanics in Massachusetts are uninsured, so we need to make sure we do everything possible to effectively reach out to this historically overlooked population. I'm excited to see how these results can inform our next Open Enrollment period."

HCFA also announced its plans for using the research results to drive a new outreach and enrollment campaign, to be run in partnership with the Massachusetts Health Connector during the 2016 Open Enrollment period.

"The first Hispanic Enrollment Week will start on Monday November 9th and will conclude with a large-scale Enrollment event in Chelsea on Saturday, November 14th. This is an important part of the work that Health Care For All is doing as a Navigator organization in partnership with the Massachusetts Health Connector and will be enhanced by an ethnic-media campaign conducted in Spanish and Portuguese," said Amy Whitcomb Slemmer, Executive Director of Health Care For All.

"As Health Care For All's report indicates, Massachusetts' Hispanic residents are uninsured at a higher rate than the rest of the state, and this has been the case for a number of years," said Louis Gutierrez, the Executive Director of the Massachusetts Health Connector. "During this Open Enrollment, which starts November 1st, the Health Connector is committed to lowering the state's uninsured rate, particularly in underserved communities. We have planned a broad range of outreach and education efforts, including very targeted messaging to communities with high uninsured rates, to provide accessible and affordable health care to more people."

Such efforts are instrumental in reaching uninsured consumers in the Hispanic community, as navigating the health care system is complicated even for those who are familiar with enrollment practices. That was the case for José Ayala-a radio host who frequently shares information with his audience about this topic-who himself faced challenges and experienced a gap in coverage:"Recently, I renewed my coverage with the Health Connector, and I received my insurance card. I thought I was all set, but when I had an emergency and went to the hospital I was told that my coverage had been terminated. I didn't realize that I had missed a key step in the enrollment process when I was asked to provide updated proof of income and I didn't follow through. Fortunately, I called my friends at Health Care For All, and they worked with the Connector to take care of the situation."

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For more, see the research reports:

State Policy Recommendations for Increasing Latino Enrollment in Health Insurance

Promising Practices for Latino Outreach and Enrollment: Lessons from Massachusetts Experience