In South Tucson, the road to affordable healthcare is paved with good intentions, but local organizations have often struggled to convert purpose into productivity when it comes to aiding the uninsured.
With a population that is more than 70 percent Hispanic, South Tucson has unique needs for health care coverage: approximately one in four uninsured American residents are Latino, and about 400,000 of those uninsured live in Arizona, according to the U.S. Department of Health and Human Services.
As many as one-third of the nation’s Hispanics are estimated to be uninsured, a statistic that exemplifies how ethnic and racial minorities demand additional attention when it comes to targeting the approximate 50 million Americans without health coverage.
Some 10.2 million uninsured Latinos became eligible for coverage, however, under the Affordable Care Act (Obamacare), according to the U.S Department of Health, either through the federal marketplace or health insurance programs on the state level, such as Medicaid or the Children’s Health Insurance Program, known as CHIP.
Gov. Jan Brewer’s decision to expand Arizona’s Medicaid program, known as AHCCCS, was instrumental in addressing the pressing needs of the state’s uninsured living at or below the poverty level, said Melissa Shafer, the community and government relations manager at Carondelet Health Network.
“Arizona has its challenges,” Shafer said, citing diabetes and obesity as major problems the state is facing as well as a high rate of uninsured residents. “So I think it was just so important that [Gov. Brewer] got behind that and she saw that we really do have a need. It was a tough battle for her… and now other states have come in behind or after her and are re-evaluating their decisions to not expand Medicaid.”
The deadline approaches
Carondelet is one of numerous health-focused organizations partnering to help Southern Arizonans get covered, but the clock is ticking: the marketplace closes on March 31, which will end open enrollment until it re-opens in the fall (enrollment in AHCCCS, however, will continue year-round).
In an effort to enroll as many of the uninsured as possible, Carondelet, along with the Tucson Medical Center, University of Arizona Medical Center and other community partners, launched their “Healthcare I Can Afford?” campaign and accompanying website, SoAzCares.org, in January. The ads have appeared on TV, radio and on billboards. On Jan. 23, Health and Human Services Secretary Kathleen Sebelius hosted a special webcast focused on the campaign.
Within two weeks of its launch, Shafer said the website had more than 1,200 hits and is “skewing high” among younger people. Meanwhile, views of the “Healthcare I Can Afford?” commercial, which hones in on the importance of preventative care, are “double the national average” for similar healthcare campaigns. Enrollment actions on the site are split almost evenly between the federal marketplace and AHCCCS.
A broader effort to reach the uninsured has been lead by Enroll America, a national non-profit that works to relay accurate and consistent information to Americans curious about their healthcare options, according to Pati Urias, the communications lead for Enroll America in Arizona.
One of their biggest challenges in months of community outreach involved misconceptions about the cost of health care. Of the approximately 30,000 people that the Arizona chapter had reached by January, “the majority” had not even considered accessing the marketplace because they either believed they were ineligible or that the plans would not be affordable, Urias said, even though Arizona’s prices are among the “lowest rates in the nation.”
“I think that’s probably the challenge that everybody has, reaching the populace of people who really need this information,” Urias said. “There are a lot of people out there who need it…so really getting out and about and reaching as many of the uninsured as possible is something that we really want to do.”
Some of the most vocal outrage over the Affordable Care Act unfolding nationwide regarded its impact on the status quo, which for some companies and organizations was seen to be nothing short of earth-shattering.
One local organization – the Pima Community Access Program, or PCAP – was forced to alter their focus from linking “low-income, uninsured residents of Pima County with an affordable, comprehensive and coordinated network of health care providers,” according to their website, to instead guiding their current members directly to the marketplace or AHCCCS. The shift has done little to change PCAP’s overall mission, however, and allows it to focus on a form of community outreach similar to Carondelet or Enroll America, according to Executive Director Michal Goforth.
“We want to help the transition and help it work, because it’s better for the [PCAP] members, it’s better for the providers, it’s really better for everyone,” Goforth said.
Since the enrollment period began, Goforth said her staff has worked to connect PCAP’s nearly 9,000 members, 67 percent of whom are Hispanic, to the marketplace or AHCCCS depending on their eligibility.
Targeting the uninsured
While PCAP and similar organizations worked to move uninsured Arizonans on the path towards getting insured, the Pima County Health Department announced in February they would make a “massive statewide effort” to get individuals and families signed up as open enrollment entered its final month. One such effort, an event dubbed “Cover Pima County,” was met with heavy rain, which all but brought a city accustomed to 70-degree winter weather to a standstill.
“The world stops in Arizona when it rains,” said Debra Johnson as she stood at the entrance of the Tucson Urban League the morning of March 1, shaking her head in equal parts amusement and disbelief. Located near South Tucson, the organization was one of more than a dozen across the city to participate in the event, but by early afternoon only a handful of people had trickled in for enrollment assistance.
Johnson, the regional navigator program coordinator at the Urban League, said the timing was especially unfortunate because there had been a “lull in enrollment” not only in the state, but across the nation in the early months of 2014.
She also said South Tucson is at “the epicenter of one of the highest zip codes of uninsured,” especially vulnerable because of its poverty rate and pressing health issues, which include high rates of diabetes and cardiovascular disease.
Certified navigators, volunteers and an insurance broker were all present at the Urban League, and were – and still are – working to combat two pieces of misinformation Johnson said had plagued the process from the get-go: that the open enrollment deadline will indeed close on March 31, and that the penalty for not enrolling is not simply a one-time, flat fee of $95.
The penalty, in fact, is $95 per adult and $47.50 per child, or one percent of the household’s gross income – whichever is greater – and is likely to increase next year, according to Alex Cooper, the business development manager of the Tucson Hispanic Chamber of Commerce who also serves as a navigator.
Johnson and Cooper have made presentations across the community in locations such as San Miguel High School and the Quincie Douglas Public Library, but Johnson acknowledged that more presentations should have been made to help alert South Tucsonans to their options. She said consistent community outreach seemed to be the most successful way to turn around a slow start caused by now-infamous technical problems, a lack of knowledge on how to discuss health insurance and a general reticence to ask for help.
“It’s unfortunate that the deadline is now because of all of the problems early on,” Johnson said. “We were in that learning curve and the marketplace was not very user-friendly. We really lost a lot of time in enrolling people.”
The turnaround in a matter of months, however, has been reassuring for Johnson and her volunteers, she added, and served to reiterate the importance of getting people covered through a movement that “is not only a health care initiative but a poverty initiative” as well.
“I think that from October to today, improvements to the marketplace have been tremendous,” Johnson said. “I’m just excited because I think this is something that so many families really and truly can benefit from. It’s history in the making so it’s exciting to be a part of that.”
Looking forward
Cooper said he believes Hispanics are among the groups most likely to benefit from the ACA because it “addresses the inequalities previously among minorities in America.” Many Latinos had pre-existing conditions that prevented them from securing coverage in the past, but people with pre-existing conditions are not excluded under the new system.
As new obstacles have fallen away, however, new ones have risen to take their place.
The centralized, technology-driven marketplace has caused woes for many who are unfamiliar with how to navigate the plan options online. This is especially true in South Tucson, where computer access in the home is fairly uncommon. The sign-up process requires an email address, which many people do not have. And if the password or answers to the rather complex identification questions can’t be entered correctly, enrollees are often left back at square one.
Christina Burns, an insurance broker, cannot access the marketplace herself after losing her password, despite the fact that assisting people throughout the enrollment process is now a major part of her job. The irony is not lost on her, but regardless of these setbacks Burns agrees the marketplace has become more user-friendly, especially in terms of becoming a one-stop shop for every step of the process. She said one of the major improvements is the feature that allows users to pay directly on the site as they view the plans rather than waiting for the marketplace to communicate with the insurance companies.
There is still confusion, however, regarding the plans offered. Currently, there are often dozens of plans available from private companies under each level of coverage – bronze, silver, gold and platinum – and sometimes up to “three or four plans per company.” Consolidating these options into “one plan per company, per level” could help ease the likelihood of being overwhelmed, Burns said.
While visitors to the Urban League on March 1 set about picking their plans with the help of Burns, Cooper and other volunteers, two of them seemed to slip through the cracks. Rafael Righinis took home a paper application after attempts to create an email account and link it to the marketplace were unsuccessful. Plus, cost estimates under the website’s calculator were out of his price range.
In short, he said, it was a “fiasco.”
“A lot of people think that, OK, you’re going to pay this amount of money, but the government can help you, so you don’t have to dish out that amount,” Righinis said regarding information perpetuated by some navigators and other professionals that tax credits can greatly lessen the total cost of coverage. “It’s not really affordable in my opinion.”
He said he plans to proceed with the paper application, but will pay the penalty if the cost is not realistic for him and his wife.
Dennis Jordan, a lifelong resident of South Tucson, had a similar experience: faced with paying about $200 a month for coverage, he opted out despite prolonged efforts to get coverage for the last year-and-a-half. However, he said his visit to the Urban League was helpful in that it cleared up conflicting information he was faced with while searching for plans online outside of the marketplace.
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For assistance
Visit the Urban League at 2305 S Park Ave. or call 520-791-9522 ext. 2221.
You can also dial ‘211’ or text ‘Locator’ to 877877 for professional help. After entering your zip code you will be sent the phone numbers and locations of nearby navigators.
The Pima County Health Departmentalso has a mapping tool available to help people find enrollment assistance.[/box]
Jordan and Righinis’ qualms seemed to be over one word – “affordable” – and their experience left them both asking, “Affordable for whom?” Jordan said healthcare reform seemed to leave hard-working people out of luck if their income left them in limbo between the marketplace and AHCCCS.
“If you’re wealthy, you’re going to have no problem, or if you’re under the poverty line, then you’re going to get AHCCCS, you’re going to get assistance or something else,” Jordan said. “But if you’re that middle of the line, middle class, you get penalized. You’re paying for everybody, and nobody’s helping you.”
In an effort to counteract that sentiment, the Urban League has been opening the computer lab in the Angel Youth Center every Wednesday evening at 5:30 to the community to continue assisting them through the enrollment process, and will do so the last week before the deadline, Johnson said.
While even those most informed about the ACA are far from certain about how the law will continue to unfold in the future, they seem assured of one thing: there’s much to be done, and many obstacles to overcome, but staying stagnant is not an option.
“When you are inspired, and you set your mind to it, nothing can stop you,” said Frank Bothwell, a volunteer at the Urban League. “Change is good, if you think about it.”