Just because President Obama pushed a healthcare law through that is aimed at insuring all Americans doesn’t mean he’s changed a country where marginalizing people of color and the working poor is a time-honored way to save a few bucks in the short-term. Unsurprisingly, then, though the Affordable Care Act (ACA) has made great strides to decrease the amount of uninsured Americans since it was signed into law in 2010, coverage for Latinos still lags disproportionately behind.
In 2013, before the ACA mandate for most Americans to obtain coverage, Latinos were already less likely than the general population of the United States to have jobs that offered insurance or paid enough for them to afford private insurance. Hispanics accounted for more than 30% of the uninsured despite being about 18% of the population.
The feds should have seen this pre-existing condition as a warning sign that they needed to better understand the hurdles to insuring working Latinos. What actually happened was that millions of Americans who live in states that chose not to expand Medicaid eligibility fell into what experts call a coverage gap: they earn too much to qualify for Medicaid and too little to qualify for tax incentives that would allow them to afford private insurance through the ACA Marketplace.
That expanded Medicaid coverage was factored into the ACA on a national level as the way that individuals with incomes at or below 138% of poverty ($27,724 for a family of three) could receive health insurance. But in June of 2012, the US supreme court ruled that it would be optional for states to expand their Medicaid coverage. The states that opted not to expand are – surprise – Republican-leaning and mostly in the south, home to 89% of uninsured Americans.
The majority of uninsured are low-income individuals, and more than half are people of color. The largest portion of uninsured, 26%, live in my home state of Texas and the next largest, 18%, are in Florida – two of the most populous states for Latinos.
In other words, it’s business as usual in the American south. Why anyone at the federal level thought this would be different – or didn’t think that this would be a problem – is beyond me. A system of ignoring the working poor is too much a part of the American way for states to just up and agree to expand coverage for them without a fight. And fight they did.
But the federal government can help mitigate the problem. It can control the outreach to the Latino community to educate those who do qualify for ACA coverage. A study in 2014 found that only 49% of potentially eligible Latinos are enrolled. The number one response received from that group about why they remain uninsured is that 41% did not believe they could afford health insurance. Additionally, 78% were unaware of financial incentives available to them, and 66% had no idea that free enrollment help was available. This is crucial, because these numbers are the kind that will bring insurance prices down for all Americans if this population becomes enrolled.
For another thing, we need more Latino representation among our elected and appointed officials so that this information gap can be better anticipated through appropriate communications strategies customized for the many subgroups of people we call Latinos living in the United States. For example, The Commonwealth Fund found that three quarters of Latinos who are still uninsured predominately speak Spanish, and almost all (79%) of these individuals say they understand or speak English “just a little” or “not at all”.
Any marketing professional knows that the second question you must ask yourself after “What is my message?” is “Who is my audience?” In the case of the ACA, a group of fifth-generation Mexican Americans in Texas must be approached differently than a group of Puerto Ricans in New York or newly arrived South Americans in Los Angeles.
Hispanics make up the United States’ largest minority group and represent its future. If the federal government doesn’t wake up to this fact and learn how to effectively communicate with this vast group of people, we’re looking at a future of uninsured, impoverished Americans.
