Hispanic enrollment in state health insurance exchange proves disappointing

Enrollment numbers in the state health insurance exchange didn’t overwhelm on any front.

But one demographic group in particular was underrepresented in the final sign-up tally, and the health of the exchange relies on turning around that low count in future enrollment periods.

Hispanics made up 17.8 percent of enrollment in private, qualified health plans through Nevada Health Link, the online marketplace through which consumers can buy insurance to comply with the Affordable Care Act’s coverage mandates.

Some observers say that’s a disappointing number when you consider that Hispanics make up 43 percent of Nevada’s 600,000 uninsured and 34 percent of the Las Vegas Valley’s population.

“The system is really missing them,” said Bobbette Bond, chief project officer for insurer Nevada Health CO-OP.

Larry Harrison, an insurance broker and Las Vegas-based spokesman for the National Association of Health Underwriters, called Hispanics the “low-hanging fruit” for enrollments — a demographic with some of the state’s smallest insurance participation rates and the group that should thus have gained the most ground in sign-ups.

But not all might be lost.

The state Division of Welfare and Supportive Services has yet to release demographic details on the state’s surging Medicaid applications, said Andres Ramirez, president of the Ramirez Group, Nevada’s largest health insurance navigator firm. He said he’s certain Hispanics will show better in the complete analysis, because the demographic made up 65 percent to 70 percent of all coverage applications his navigators filled out.

Ted DeCorte, chief operating officer of navigator firm Consumer Assistance and Resource Enterprise, added that 60 percent of the people his group enrolled were Hispanics, and the demographic segment might see a coverage boost through Medicaid.

Also, carriers still are counting sign-ups from an enrollment push just before the March 31 deadline. One event at Cashman Center brought in more than 10,000 consumers; Ramirez estimated that more than half of attendees spoke Spanish.

Still, observers agreed exchange officials, enrollment experts and carriers need to do more to encourage Hispanic enrollment. That’s because Hispanics are such a large share of the uninsured that the system won’t work the way it’s supposed to without the group opting in.

“The Latino population is a growing part of our community. If we don’t figure out a way to make all of our services work for the Latino population, and get them engaged in purchasing those services, we really aren’t going to be successful in Southern Nevada in the long-term,” Bond said. “We’re going to keep working on it. We don’t think the Latino population can be ignored.”

Added Ramirez: “If the priority is to reduce the number of uninsured people in the state, and the largest share of uninsured is Hispanic, then there needs to be a specific plan to deal with reducing that population of uninsured.”

ANSWERS Might BE COMPLEX

There’s no simple answer for why Hispanic enrollment fell short of potential, experts said.

It could be simple reporting — some people might not be stating their race on their application, said Brent Leavitt, a broker with Nevada Benefits in Las Vegas. Others might just not want coverage, he said. They were uninsured before, and the still don’t see the need to buy insurance now.

Rising premiums haven’t made coverage an easier sell, Harrison added. An individual plan for a younger enrollee would have cost $89 a month and a maximum of $2,000 out of pocket in 2013. That jumped to $200 a month and out-of-pocket costs of as much as $6,250 in 2014. Anyone who didn’t buy at the lower cost isn’t likely to leap at today’s pricier policies, he said.

Then there are potential cultural issues.

Uninsured Hispanics aren’t accustomed to buying benefits, and they might not have known where to turn for help, said local insurance broker Richard DiGregorio.

They also could have a preferred fallback.

“They may not trust the doctors in this country,” Harrison said. “They say, ‘If I get hurt or need medical care, I’m going back to my country, where it will not cost anything.’ Why give the system here $100 to $200 a month?”

But Ramirez said he’s not sure culture was a big contributing factor. Sure, “cultural differences and disconnects” exist, but those issuse are more common among undocumented or new immigrants, who weren’t eligible to enroll through Nevada Health Link anyway.

Cultural issues or not, Nevada Health Link’s website hasn’t helped, brokers said.

The Spanish-language portal debuted six weeks late, in mid-November, and there was no build-up for its launch, DiGregorio said. Nor is the portal’s existence clear when you go to the website. There’s a small planet Earth in the upper right section of the site, and visitors must click on it to get the “Español” option. The average person probably wouldn’t be able to figure that out, he said.

In fact, the Spanish-language website might not even be the best option for Hispanics who speak English as a second language.

Bond, whose CO-OP is cosponsored by the Culinary Health Fund, said very few people use the health fund’s website if English is their second language. That’s why the CO-OP decided to hire 18 bilingual staffers for its Meadows Lane walk-in office.

“This is a population that is just getting used to health insurance in some instances. The exchange website was super-complicated even when it was working,” she said. “The application process was really long. Having a walk-in center has really helped us enroll people where there are language barriers.”

Those experiences give Bond and other observers ideas on how to make the system work better when the next open enrollment session kicks off Nov. 15.

WALK-IN CENTER SUGGESTED

First, the exchange should not ditch its Spanish-language website. It does need to work in the long run, because the Affordable Care Act’s exchange model works only if people can sign up online, Bond said.

What would help is an expedited process. Not many people have an hour to wade through an application process just to shop for a qualified health plan, she said.

The website isn’t the only answer, though. The CO-OP’s Spanish-language portal worked seamlessly from Day One, and the carrier still hit just 17 percent on Hispanic enrollments.

Exchange officials didn’t respond to a request for comment by press time, but Bond suggested the marketplace open a walk-in center like the CO-OP’s.

“They need a way for people to be able to talk to a live person,” she said.

That’s why enrollers and carriers said they plan as much one-on-one contact as possible the next time around.

The CO-OP has worked with the Latin Chamber of Commerce, Latino real estate agents and insurance brokers that target the population. It also rolled out television and radio ads as enrollment neared.

“I still feel like we have a lot of work to do,” Bond said.

The CO-OP will switch its strategy going forward, holding events in its walk-in center rather than focusing on a presence through other community groups and happenings.

For the Ramirez Group, a plan of attack is waiting on those Medicaid numbers. If the program’s Hispanic sign-ups hit 40,000 to 50,000 or more, the firm will ask how many potential members are left in the pipeline.

“At some point, you have diminishing returns when you’re enrolling. We want to see the data to understand where we need to be, and what efforts we need to increase,” Ramirez said. “In the meantime, our approach is very basic: Go get everybody and do as much as we can. Whether we meet them at a park, church, community center, hospital or health center, we are going to be where uninsured populations go, and we are going to enroll them.”

Contact reporter Jennifer Robison at jrobison@reviewjournal.com or 702-380-4512. Follow @J_Robison1 on Twitter.