Enrolling the Latino population in the state-run health insurance exchange has long been viewed a linchpin in the success of Covered California — and Obamacare as a whole. Despite initial marketing and outreach challenges, many are viewing the uptake of this large, underserved population a success as early enrollment statistics begin to roll out — largely thanks to an increase in cultural sensitivity in enrollment practices.
“All along, Latinos have been a target demographic,” said Gary Rotto, director of health policy at San Diego’s Council of Community Clinics. This is because many of the uninsured Latino population are young and healthy, helping boost overall enrollment statistics because they present lower financial risk, Rotto said.
From a sampling of clinics in March, Rotto observed that around two-thirds of the patients were Latino. A large portion of the patients were actually eligible for Medi-Cal, though few realized it when they approached the Council for help in enrolling in Covered California, Rotto said.
The Council of Community Clinics consists of 16 organizations, with more than 120 sites of care throughout San Diego, Imperial and Riverside counties. Some 120,000 individuals look to the clinics for primary care needs — a figure that will increase as more are enrolled in insurance plans.
Nearly 60 percent of the state’s uninsured population has been Latino, according to a December 2013 report from the California Health Care Foundation, before open enrollment began. More than 46 percent of state residents eligible for government health insurance subsidies are Latino.
Marketing Was Increased Q1
But the state faced criticism in its early days of marketing Covered California.
Covered California identified in January that its enrollment of the Latino population was not at pace with other communities. So the system wound up switching tactics. The state exchange said it increased marketing efforts to the Latino population by 73 percent between January and March, and added to its Spanish language website. More than 5,000 of the agents certified to help individuals navigate Covered California spoke Spanish.
“We felt there had to be a lot of person-to-person engagement,” Rotto said. “That’s been part of the barrier — people may be somewhat proficient in English, but are more comfortable to talk about personal or medical issues in their native languages.”
Instead of driving people to a 1-800 number or a website, there needed to be regular interaction with folks in the community who needed the information about health care. And with the launch of six San Diego-specific health plans, it became a challenge for many to decipher which was the best fit, Rotto said. For the average person, trying to determine which is the best plan — and which actually included their doctor in its network — was particularly daunting.
“Those folks never had a choice before,” Rotto said. “They needed a lot of personal resources, but also trust.”
Enrollment Increased in March
The state’s Latino enrollment for health insurance increased by 32 percent in the first three weeks of March. By contrast, in the first three months of open enrollment, only 18 percent of those who applied on the exchanges were Latino, Covered California said. The exchange planned events at barbershops, drugstores, colleges and libraries to help increase the enrollment of Latino youth in particular.
Statewide, 28 percent of the 1.1 million enrolled in Covered California through March 31 were Latino. About 35 percent were white, 21 percent Asian and 3 percent black. As of April 15 that figure rose to 1.4 million enrolled in Covered California, though demographic-specific breakdowns were not available as of press time. Each racial segment outpaced expectations for the exchange.
In the same time frame, about 12 percent of the individuals enrolled were reported as Spanish speakers, while 81 percent spoke English primarily.
“Many people needed multiple touches before they understood their options and felt prepared to choose the plan that was right for them and their family,” Covered California Executive Director Peter Lee said. “They needed in-person help from agents, certified counselors, county workers or Covered California’s customer service staff to help them with their enrollment.”
Business Grows Helping Underserved
One company that has grown substantially by finding a market value in building such trust is Chula Vista-based South Bay Health & Insurance Services, which operates in a similar fashion as Covered California with Latino and other minority populations. The company is growing at a rapid pace, reaching out largely to underserved populations that are eligible for — but may not understand the intricacies of — Medicare and Medi-Cal.
The companies help seniors and the uninsured find ways to enroll in health insurance and navigate the treacherous waters of affordable prescription drug coverage. And key to its success is its focus on engaging with the communities it serves, said Thomas Holm, who co-founded the company with his wife in 2006 and now is its chief financial officer. The company has 1,700 agents who speak Spanish, Chinese, Vietnamese and a number of other languages in 16 locations, eight of which are in California.
Currently, SBHIS’s employee base is made up of some 80 percent minority or bilingual insurance enrollment agents.
“We know that when you target a Latino group, we know they’re not just Latino. They’re Mexican, Puerto Rican, Chilean. … There are so many different communities,” Holm said. “The difference with us is that we’re very specific to different ethnic groups. You have to be very culturally sensitive and culturally diverse.”