Latinos make up 25% of Access Health CT’s target group for enrollment in the health exchange, and with today, December 23rd as the first of the enrollment deadlines, there is no clear indication of how successful the state’s health exchange has been in enrolling Latinos and its CEO candidly admits, their effort to reach Latinos started months after the general campaign began in July.
Access Health CT, Connecticut’s state health exchange was created under the Affordable Health Care Act, also known as Obamacare. Nationally, it has had numerous problems, and while Connecticut has been mentioned as one of the more successful programs, it’s still hampered by federal glitches.
Last week, Kevin Counihan, the Chief Executive Officer of Access Health CT, stated on National Public Radio that the exchange’s Spanish Language Site was not ready to go live, nor would it be ready this month, in spite of the December 23rd deadline.
Also, although the health exchange began enrolling residents on October 1st, currently, no information is available on some simple facts related to Latino enrollment, such as: Are Latinos signing up for health plans through Access Health CT? At what pace? How many of the 47,000 participants enrolled to date are Latinos? CEO Counihan candidly admits they do not have even the vaguest of ballpark guesstimates and it’s not because its a matter of withholding unflattering numbers; they simply just do not have them.
The reason for no readily available numbers on Latino registrants Counihan says is because of the federal government’s guidelines. “The Center for Medicare and Medicaid Services (CMS) does not allow those fields to be mandatory.” In other words, people signing up for health insurance do not have to fill in these blanks on forms or websites, he said. Adding, “I pushed them to make it mandatory so that we could have some real data, because we are trying to see what kind of effect we are having in terms of access disparities, but they have refused to make it a mandatory field.” CMS is a federal agency within the United States Department of Health and Human Services, and it oversees state insurance exchanges like Access Health CT.
Counihan said he has discussed the issue of using sampling to get a count on Latinos and other demographic groups with Frances Padilla, President of the Universal Health Foundation, which laid the groundwork for the state’s health exchange.
As for the exchange’s Spanish Language Website, that might have provided some insight on Latinos signing up, it is still not operational. “The goal all along was to have that available concurrently with the English version, on October 1st,” Counihan said. “I thought it was just a matter of having a site in English that you would then convert to Spanish, like you would convert to any other language. It turns out that it’s like having two sites. It’s not like you can just take all the words in the English version, find a Spanish translation for it, code it in, and you’re done. You literally have to set up a separate site. It’s literally twice the work, and it took more than twice the effort.” The words are actually done. Deloitte is working on programming it, but it won’t be up and running for a month or so.” Deloitte is the consulting firm that Access Health CT is using as a system integrator for the website.
The organization also didn’t reach out to most Latino media outlets until October and had not utilized available Husky Medicaid information channels like postcards or that program’s website. If any efforts to reach out to Latinos have fallen short, this has been addressed, according to Counihan. In September, Andrea (Montero) Ravitz was hired as the Multicultural Marketing Manager for the organization. Previously with Aetna, Ravitz comes from Costa Rica, having moved to Connecticut in 2007. She earned a bachelor’s degree in Advertising and an MBA in marketing from Universidad Latina de Costa Rica. Prior to her arrival, there appears to have been no Latinos in the top management positions at the Access Health CT according to its website.
“Our projection has always been that out of the first 100,000 enrolled, 25,000 is what we are targeting from the Hispanic community,” she said. “We know that families are extremely important when it comes to health care decisions, and that teachers play a very, very important role. So do doctors. You trust doctors more than you do a lot of people. So when somebody goes to the doctor, and they say ‘What is Access Health CT?’, whatever response they get from their doctor is going to resonate more than an advertisement, or some piece of collateral that we can send. So one of the most important things to us is to make sure that we are communicating with and educating all these influencers to really spread the word in the right way.”
“We’ve actually started an outreach to churches, where they will tell the community that attend their services who we are and what we’re trying to accomplish. When somebody who is considered an influencer in your life says something, that’s going to be more important than anything we can put out there. We’re using social media, putting out messages that resonate to young people, and also moms, the people we know who at the end of the day are going to make the decision of what to buy, when to buy, and who to buy it from.”
Counihan noted that while working on healthcare in Massachusetts, he found that young Latino males were the most difficult to reach when talking about health care. “We learned that the most effective thing to do was to go through their mothers,” he said.
Ravitz continued, “You’re going to see that, yes, we have mass media out there. We have radio; we have TV. We have a lot of interviews out there. But it’s really about making it personal, face to face.” She also asserted that the person-to-person outreach efforts so far, including phone lines, “assistors” and enrollment fairs, has been effective in reaching a significant numbers of Latinos. She said that opening enrollment centers in New Britain and New Haven was calculated to maximize the visibility of Access Health CT to Connecticut’s urban Latino populations.
However, much of the broader outreach that Ravitz described hasn’t happened yet, she said. “December 23rd is the last day for people to get covered if they want to get coverage starting January 1st,” Ravitz explained. “That doesn’t mean that after the December 23rd, you can’t enroll and you have to pay a penalty. What happens if you enroll on the 24th? That means that your health coverage is not going to start until the 1st of February. On the 31st of March, that is when we hope to have 100,000 enrolled, and that is the date when people without insurance will start paying the fine.” The penalty is either $95 per adult or 1% of family income, whichever results in a larger fine.
As far as impact on those already covered under Medicaid/Husky right now, Ravitz said, “My understanding is, as long as you currently have your coverage, there’s really nothing you have to do,” she said.
What about people with residency status issues? “Say that I have legal status but my husband doesn’t. This law covers legal residents of the state of Connecticut.” Ravitz went on to explain how Immigration and Customs Enforcement (ICE) has no way to find out if anyone without legal status resides in a household when legal residents apply.
Concerns like this one reveal that as complicated as health insurance can be for any individual, Latinos might have even more complicating concerns. Kevin Counihan grappled for a metaphor to describe the scale and complexity of the task at hand. “I think a good comparison is Medicare,” he said at last. “When Medicare started back in 1965, it was a similarly very broad expansion of access to care. It took about five years to stabilize. That’s not going to be the case here. This thing will stabilize in two, two-and-a-half years or so.”