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September 20, 2017

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Enrollment of Hispanics a key factor in the future of Obamacare


Sam Morris / Las Vegas Sun

Ceci Walters assists Waldemer Morales in signing up for health insurance at the Nevada Health Co-Op Wednesday, March 12, 2014.

Gilberto and Maria Avelar had been living with chronic medical conditions and no health insurance for years, when their luck ran out in October.

Maria, who had a kidney transplant in 2006, had an infection and her kidney failed. After a two-week stay in the hospital, she received a $100,000 bill.

She negotiated it down to $50,000, and is on a payment plan, but the incident drove home the fact that Maria, 54, and Gilberto, who is 63 and diabetic, needed insurance.

The couple is emblematic of a group of uninsured people who are important to get enrolled — Hispanics, and more importantly, Hispanics with chronic illnesses.

Prior to the start of the Nevada Health Exchange, the health insurance marketplace set up under the Affordable Care Act guidelines, Hispanics accounted for 43 percent of Nevada’s uninsured population. While 15 percent of non-Hispanic whites in Nevada are uninsured, 36 percent of Hispanics lack insurance. National numbers are similar.

There are not yet national figures on enrollment by race and ethnicity, but Hispanic advocacy groups such as the National Alliance for Hispanic Health have recently raised concerns that not enough Hispanics are signing up based on preliminary numbers from some states. President Barack Obama has reached out to Hispanics specifically in television appearances and community meetings, imploring them to enroll.

“When we look at how we are going to reduce the numbers of unenrolled (in Nevada) but also decrease the burden on the emergency services — where people go to when they don’t have insurance — we are going to do that only by enrolling Hispanics in a health care system,” said Andres Ramirez, director of the Ramirez Group, one of the agencies in Nevada certified to assist in the enrollment process.

Meanwhile, recent studies show Hispanics are more prone to a host of chronic conditions that would be best managed with insurance and regular doctor visits.

Hispanics have higher rates of hypertension, obesity and stroke than non-Hispanic whites. Additionally, Hispanics are almost twice as likely to develop type-2 diabetes. A study by the National Institute of Health found that 1 in 3 Hispanics has pre-diabetes and among those with the disease, just half have their condition under control.

These are all conditions that are much easier to manage with regular doctor visits and insurance to cover tests, treatments and medications, said Dr. Darren Rahaman, chief medical officer at Nevada Health Centers, a network of clinics that serve many of the state’s uninsured.

“Diabetes is one example, but really it’s anything chronic, where basic intervention with the primary care provider early on can make a big difference,” Rahaman said. “They are getting information on diet, exercise, smoking and other risk factors.

Gilberto and Maria both work at a mattress factory in east Las Vegas, but do not have insurance through their work. Because of their pre-existing conditions, Maria says the couple have been either denied coverage in the past, or what they were offered was prohibitively expensive.

After her kidney failure, she had to start going to the University Medical Center emergency room for dialysis three times a week. She would arrive by 6:30 a.m. and stay all day, because the hospital is overwhelmed with patients needing dialysis.

The Avelars signed up for insurance on the Nevada Health Exchange in December, and now Maria can schedule her dialysis appointments at a clinic and only miss a half-day of work each time. Additionally, now her six medications and treatments are covered by her insurance.

“Insurance adds quality to their life,” Rahaman said. “You can diagnose things earlier, and you prevent them from going to the emergency room, which is a real burden on hospitals. Insurance helps people get their diabetes under control because it provides for greater access to medications and regular care, and then they hopefully don’t need dialysis.”

Rose Marie Ortiz, 64, has been without insurance since August, when she was laid off after 36 years as an assistant to a hospital administrator. Ortiz suffers from scleroderma, an autoimmune disease that causes skin to harden. She has had four fingers amputated, has many complications from the illness and needs regular visits with various specialists. She takes 13 medications.

After Ortiz was laid off, the only insurance she could get was a COBRA plan for $823 per month. After signing up on the Nevada Health Exchange, she and her husband are now insured for $102 per month.

“There have been a few times that I’ve been really sick and didn’t go to the doctor because we just couldn’t afford it, but then things can get worse,” Ortiz said. “I’ve been putting off visits to my doctor and my specialists, but now I can start going back.”

The Ramirez Group helped both the Ortiz and Avelar families sign up for insurance.

At the end of February, more than 6,000 applications had been facilitated through the Ramirez Group, and each application can have either a single person or whole family on it. Of those, an estimated 70 percent have been Hispanics, despite no specific outreach to the group, Ramirez said.

He added that many people who come in to sign up for insurance through the exchange find out they are eligible for Medicaid through the program’s expansion under the Affordable Care Act. So, while they are getting insurance, they are not included in the people enrolled through the exchange.

Insurance provider Nevada Health Co-Op has made a concerted effort to reach the Hispanic community, running advertisements in Spanish and English and teaming up with the Mexican Consulate. Just 17 percent of the people who have enrolled through the exchange at Nevada Health Co-Op self-identify as Hispanic, according to Pamela Egan, Co-Op chief development officer.

“There is certainly the opportunity to get more of the Hispanic community through the door, and we’re trying to get the message out to them,” Egan said.

After hiccups mirroring the federal ones, including a delayed launch of the state’s Spanish-language health care website and promotional campaign, the Nevada system is working much more smoothly than when it debuted.

“When the website launched it took two to three hours to get through an application,” Ramirez said. “Now, it takes 20 to 30 minutes.”

There was a rush of applications when the health exchange launched in the fall and into December, and insurers and navigators are expecting a second rush as the enrollment deadline approaches on March 31. That deadline was extended last week for people who have already tried to apply, but ran into issues with the system.

Preparing for the rush, on Saturday, the Ramirez Group and Nevada Health Exchange are holding a health fair at Cashman Center from 8 a.m. to 8 p.m. where people can enroll and get more information.

“The majority of Hispanics coming to us have never had insurance before,” Ramirez said. “Even if the information is available in Spanish, they often don’t understand what the options are … They have all these questions, and it’s a process.”

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