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Many Latinos Shun Obamacare For Fear Of Getting Relatives Deported

Many Latinos Shun Obamacare For Fear Of Getting Relatives Deported

By Soumya Karlamangla and Chad Terhune, Los Angeles Times

LOS ANGELES — Lilian Saldana turned down Obamacare coverage once, and she might do it again.

With sign-ups set to resume Saturday, the 23-year-old Covina resident and her younger sister are hesitant to enroll because their parents are immigrants who are not citizens and therefore ineligible for benefits under the Affordable Care Act.

Saldana, an after-school tutor, admits she could put the insurance to good use for a checkup, but she worries about putting her parents at risk or creating a rift at home.

“We’ve always done things together as a family,” she said.

The Saldana sisters are among roughly 600,000 Latinos in California who remain uninsured — despite qualifying for subsidized coverage under the federal health law. Latinos outnumber whites and Asians among the 1.3 million Californians who are eligible for federal aid and lack private health coverage.

California officials, sensing continued reluctance from people such as the Saldanas, are tackling the immigration fears directly for the first time in new TV ads. One commercial shows documents flying into a vault as a Latino man tells viewers their information is “confidential and private.”

This is part of $95 million the Covered California exchange will be spending on marketing and outreach in the months ahead. California accounted for 15 percent of enrollment nationwide during the initial launch, and the Obama administration is counting on the Golden State to deliver another big turnout.

Open enrollment runs from Saturday to Feb. 15.

But it will be a hard sell to many Latino families of mixed immigration status.

People living in the U.S. illegally are not eligible for coverage under the health law. For that reason, some residents are nervous about answering detailed questions about family members who aren’t applying, and they worry that turning over this information could lead to deportation for spouses, siblings or other relatives.

Those fears were heightened this year when a wave of Central American children crossing the border illegally sparked angry protests and President Barack Obama backed off immigration reform in the fall amid stiff opposition.

Despite repeated government assurances that no information is shared with immigration authorities, some Latinos are willing to gamble with their health rather than risk having their family torn apart.

“This is a very big deal in California,” said Catherine Teare, senior program officer for health reform at the California HealthCare Foundation. “It’s really hard for Covered California or anybody to make those concerns go away.”

Compounding the problem, the state has often fumbled its outreach to this crucial demographic. Covered California opened last fall with no application in Spanish, bland advertising and a shortage of enrollment counselors in Latino neighborhoods.

State officials say they learned from their mistakes and expect to build on a late surge of Latino enrollment last March and April. There’s little margin for error because the upcoming open enrollment lasts three months, half the time before.

“We have to address this issue of immigration status head on,” said Peter Lee, executive director of Covered California. “We need trusted voices saying it’s safe.”

Overall, about 3.4 million Californians have gained health insurance in the last year through private insurance or an expansion of Medi-Cal, the state’s low-income health plan. The percentage of Californians who are uninsured was cut in half to 11 percent by June, according to the Commonwealth Fund, a private foundation that studies health policy.

By mid-February, Covered California wants to sign up 500,000 more people to private health plans, in addition to the 1.2 million who did so during the first open enrollment.

Statewide, 62 percent of those who remain without insurance are Latino, according to a survey by the Kaiser Family Foundation.

About half of those people aren’t U.S. citizens or legal residents, so they can’t get insurance through the exchange or Medi-Cal. Among those who are eligible, 37 percent said they were at least somewhat worried that signing up for health insurance would draw attention to their family members’ immigration status.

Hugo Ramirez, who manages Covered California outreach for nonprofit group Vision y Compromiso, remembers a man who called a radio talk show that Ramirez was appearing on last year. The caller said he was a U.S. citizen but his wife was not.

“I’m afraid that if I give this information it’ll be used against her,” Ramirez recalls the man saying.

A Latina in Bakersfield, in a recent consumer survey, told the California HealthCare Foundation she felt Obamacare might be a trick to get undocumented immigrants to apply and identify themselves.

In March, Obama went on the Spanish-language TV network Univision to assure Latinos that information would not be turned over to immigration officials. The federal government has deported more than 2 million people since Obama took office.

During the first open enrollment, the exchange urged outreach workers to carry a letter from U.S. Immigration and Customs Enforcement echoing Obama’s promise. But that agency letterhead merely made some people more nervous, Lee said.

This time, Lee said he’s drafting letters on immigration bearing the names of Covered California and immigrant-rights groups that are well respected in the Latino community.

Covered California had already altered its advertising to promote in-person assistance at local clinics and churches because Latinos weren’t always comfortable discussing immigration issues over the phone or online.

The exchange credited that shift in marketing for a boost in enrollment. The exchange had signed up 75,000 Latinos by the end of December, drawing criticism from state lawmakers and other health-law supporters. The state’s total grew to 367,000 by mid-April.

Bigger penalties for the uninsured might also be a motivating factor in the months ahead. The fine for going without coverage increases next year to $325 per adult or 2 percent of household income, whichever is greater.

Another challenge is enrolling Californians who have grown accustomed to living without health insurance. They may pay cash at local clinics or travel to Mexico for care.

Nearly half of the remaining uninsured in California have been without coverage for two years or more, according to the Kaiser Family Foundation.

The Saldana family has learned to cope without insurance, said Lilian Saldana, and she recently took her mother to a neighborhood clinic for a physical. But she worries about what will happen if either of her parents suffers a serious illness.

“My family’s being held back whether I apply for it or not,” she said. “There’s nothing I can do about it.”

MCT Photo/Gina Ferazzi/Los Angeles Times

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Obamacare Enrollment Varies Widely From State To State

Obamacare Enrollment Varies Widely From State To State

By Noam Levey, Tribune Washington Bureau

WASHINGTON — Sign-ups for insurance through President Barack Obama’s health-care law varied widely across the nation in the first year for the system’s state marketplaces, according to a new government report that shows consumers flocked to coverage in some states while enrollment fell well short of targets elsewhere.

These differences could have a major impact on what happens to rates next year, with added pressure on consumers in states with low enrollment.

Enrollment lagged the most in states that were running their own marketplaces, including Massachusetts and Oregon, which struggled with their online systems. The two states fell more than 70 percent short of their goals.

Even several states considered successes, including Kentucky, had relatively few sign-ups for marketplace plans, though Kentucky had strong Medicaid enrollment. Altogether, 20 states fell short of projections made last year by the Department of Health and Human Services.

By contrast, Connecticut, Rhode Island, New Hampshire and Florida all recorded more than twice as many sign-ups as federal officials had hoped for.

California, which led all states with more than 1.4 million sign-ups, had 8 percent more than projected.

“While there is a lot of focus on the national numbers, it’s what is happening state by state that will affect how much premiums rise next year,” said Kaiser Family Foundation Senior Vice President Larry Levitt, an insurance expert.

“Insurers set premiums based on who signs up in a state. If lots of healthy people enrolled in California, that doesn’t spill over into Texas and help the risk pool there.”

The Obama administration Thursday celebrated the national tally, which was 8.019 million through April 19, according to the administration.

A flood of sign-ups in late March and in the extended April enrollment period included many younger consumers, who are prized by insurers because they typically cost less.

The report indicates that national Medicaid enrollment increased by 4.8 million between Oct. 1 and the end of March, as low-income Americans signed up for the program.

“We are ensuring that health coverage is more accessible than ever before, which is important for families, for businesses and for the nation’s health and well-being,” Health and Human Services Secretary Kathleen Sebelius said.

The law’s critics charge that far fewer of the new enrollees have paid their premiums. But insurance industry officials have put the payment rate at around 85 percent.

Wellpoint, one of the nation’s largest insurers, reported this week that about 90 percent of its new customers had paid their premiums.

The company also backed off earlier warnings about big 2015 premium increases, reporting in a call with investors that a late surge of young customers had improved the company’s risk pool.

However, executives at the company cautioned rates could increase more in some parts of the country.

The health law allows Americans who do not get coverage through an employer to select a plan on state-based marketplaces where insurers must offer a basic set of benefits. Insurers can no long turn away sick customers.

Americans making less than four times the federal poverty level — or about $94,000 for a family of four — qualify for government subsidies in most parts of the country.

The Obama administration is already in intense discussions with insurance industry leaders to try to keep premiums from spiking in select, high-risk markets around the country.

Industry officials are most concerned about states where insurers continue to sell health plans that do not meet new standards set out in the law.

These noncompliant plans are not being offered on the new marketplaces and so allow many healthy consumers who have such plans to remain out of their state marketplaces.

That, in turn, means that the mix of consumers who are getting health plans on the state marketplaces tends to be sicker, creating a bad risk pool.

The marketplaces depend on having a mix of healthy and unhealthy consumers to balance risk and keep premiums in check.

About half the states have allowed insurers to continue to sell these plans, an option Obama gave states last year amid public outcry over the cancellation of many plans.

Low enrollment in many of these same state marketplaces threatens to exacerbate problem of a bad risk pool.

By contrast, insurers in states with stronger enrollment — including HealthNet and Blue Shield of California, two of that state’s dominant carriers — have been more upbeat about the premium picture.

“The most encouraging thing is the sheer number of people who enrolled,” Blue Shield of California CEO Paul Markovich said at an industry convention last week. “If the number is really big, they can’t all be old and sick.” Markovich said the bigger threat to rates may come from rising medical prices.

In the longer term, the mixed enrollment picture may also impact Americans’ health.

In addition to variations in marketplace sign-ups, state enrollment in Medicaid is diverging as only about half the states have elected to expand their programs under the health law.

Recent polling from Gallup indicates that between 2013 and the first quarter of 2014, the uninsured rate fell from 16.1 percent to 13.6 percent in the 21 states that are expanding Medicaid and have elected to fully or partially operate their own insurance marketplaces, rather than defer that job to the federal government.

The uninsured rate dropped a third as fast in the remaining states that have not fully embraced the law, from 18.7 percent to 17.8 percent.

Residents of states with higher levels of insurance coverage typically have fewer problems seeing the doctor and get more recommended medical care. They also tend to live longer .

“It doesn’t matter how good the care in a particular state is, if people can’t get in the door, they can’t receive high-quality care,” said David Radley, a researcher at the Commonwealth Fund, a nonpartisan foundation that has extensively analyzed disparities in health-care systems nationally.

Photo via Flickr

Health Official Says 7.5 Million Americans Now Signed Up For Obamacare

Health Official Says 7.5 Million Americans Now Signed Up For Obamacare

By Daniel Rothberg, Tribune Washington Bureau

WASHINGTON — Enrollment in health care exchanges created under Obamacare has risen to 7.5 million and is expected to continue increasing, Health and Human Services Secretary Kathleen Sebelius told a Senate committee Thursday.

Sebelius’ announcement marks a 400,000-person uptick since Obama announced last week that 7.1 million Americans had signed up for coverage through marketplaces on the final day of open enrollment. The administration’s original tally includes Americans who, because of issues signing up, received an extension until April 15.

“During these past six months, millions have obtained the security and peace of mind of affordable health coverage,” Sebelius said during a Senate Finance Committee hearing about her department’s budget for 2015. “Many of the people I’ve met have told me that they’ve been able to get covered for the first time in years. And some have insurance for the first time in their entire lives.”

The Congressional Budget Office originally predicted that seven million Americans would sign up through the health law but lowered its estimate by one million following the botched rollout of HealthCare.gov. Passing the seven million mark last week was already an achievement for an administration that faced a new flurry of attacks after the site’s disastrous launch.

But Obamacare remains a politically sensitive issue, especially as Democrats hope to keep control of the Senate by winning elections in moderate states where many Republican candidates are vigorously campaigning against the law. Support for the law remains divided on partisan lines, with 73 percent of Democrats and only 10 percent of Republicans in favor of the law, according to a Pew Research Center/USA Today poll released Thursday.

The survey, conducted April 3-6, after the April 1 open enrollment deadline, also shows that nearly half of independents believe the law will affect the country negatively. When asked how a candidate’s stance on the law would affect their vote, 60 percent of those opposed to the law said it would be a very important factor, compared to 48 percent who support it.

Sebelius’ announcement met pushback from Sen. Orrin Hatch (R-UT), who said questions remain, including whether enrollees will pay their premiums and how many included in the tally already had health coverage before the law.

“So far, it appears that the administration is hoping that the public will ignore these important questions and only focus on the number of claimed enrollees,” Hatch said.

Sen. Ron Wyden (D-OR), who chairs the committee, began his opening statement by highlighting “overlooked” health care improvements since passage of the law. He also cited a recent Gallup poll that shows the rate of uninsured Americans hitting its lowest point since 2008.

“There’s plenty of debate about which Americans enrolled in the Affordable Care Act and when, but the independent data shows that the number of uninsured is significantly lower than it has been in years,” Wyden said.

During the hearing, Sebelius noted that three million Americans also enrolled for Medicaid coverage between October and the end of February.

“Now we know that if more states move forward on Medicaid expansion, more uninsured Americans will be able to get covered,” she said.

AFP Photo/Joe Raedle

Mass Surge In U.S. To Sign Up For Obamacare

Mass Surge In U.S. To Sign Up For Obamacare

Washington (AFP) — Hundreds of thousands of Americans rushed to buy President Barack Obama’s new health insurance plans, prompting a victory lap from a White House that paid a steep political price for its greatest achievement.

The scramble to sign up under Obama’s health care law at the end of a six-month enrollment window caused website glitches and long lines at on-the-spot enrollment centers.

But Republicans renewed a vow to repeal the law, which they say costs jobs, handcuffs small businesses and represents a government power grab in the private health care market.

The Health Insurance Marketplace was preparing to close on a record breaking day of operations — with more than three million visits to HealthCare.gov and more than one million calls to the call center as of 8 p.m. (GMT), a U.S. official said.

It remained unclear, however, how many of those people went through the whole process of securing Affordable Care Act insurance plans.

“I signed the #ACA so millions could know the peace of mind that comes with health insurance,” Obama wrote in a tweet.

In a rare moment of triumph in Obama’s so far grim second term, senior White House officials saw the deadline day rush as vindication after the disastrous roll out of the health care website late last year.

“There has been a remarkable story since the dark days of October and November,” said White House spokesman Jay Carney.

Officials said a problem with the Healthcare.gov website stopped people from establishing new accounts several times.

But Health and Human Services Secretary Kathleen Sebelius nevertheless hailed the “huge surge day” in an interview with HuffPost Live.

It will be months, however, before the long-term success of Obamacare in broadening access and making medical insurance affordable can be assessed, and the law remains a political albatross for the president and fellow Democrats.

The law demands that all Americans have health insurance or pay a fine, but offers subsidies for the less well-off to sign up.

The White House said that the final enrollment figures for the first year would be substantially higher than the six million figure already recorded. Officials had earlier set seven million enrollments as the standard for success.

The health care law is Obama’s signature domestic political achievement and the most sweeping social reform in decades in the United States.

Yet its passage and implementation ignited a partisan battle and highlighted deep ideological divisions cleaving the United States.

Republicans, however, are rubbishing administration claims, warning that the new law is crippling small business owners and costing jobs.

“I think they’re cooking the books,” Republican Senator John Barrasso told Fox News Sunday.

Republican House Speaker John Boehner warned “the problem was never just about the website –- it’s the whole law.”

“Millions of Americans are seeing their premiums rise, not the lower prices the president promised,” he added, renewing his vow to repeal the law.

Objective judgments on Obamacare are hindered by a lack of detail in enrollment figures offered by the administration.

It is unknown how many young people have signed up — an important indicator since they are needed to subsidize higher costs of older, sicker patients.

If Obamacare pools skew too old, the cost of premiums could rise next year.

Also unclear is whether everyone who registered for a health plan actually paid for it.

Another unknown is what percentage of those signing up had no prior coverage — a key metric in assessing if the law helped 40 million Americans who lack insurance.

Vice President Joe Biden visited a “one stop” sign-up center in Washington, and told people waiting to enroll that although the process was complicated, it was worth it.

“You are going to be better off for it. The country is going to be better off for it,” Biden said.

As a whole, the health care law remains unpopular: a recent Pew Research poll found that 41 percent approved of it and 53 percent opposed it.

The partisan breakdown of the poll tells the political story — eight percent of Republicans supported the law, compared to 72 percent of Democrats.

The health care row has helped send Obama’s approval ratings to record lows, and Democrats battling to cling on to Senate seats in conservative states are struggling to shrug off the backlash.

Official White House Photo by Pete Souza