MIAMI — Paul Salazar knew that being an application counselor for the new federal health insurance exchange would be a challenge.
As a Spanish-speaking community health center counselor, he was prepared to translate the complicated program for fellow Hispanics. One-third of Hispanics don't have health insurance, and they are a key focus for the Affordable Care Act plan enrollment now underway.
There have been issues. Many have received misinformation out in the community and thought the “Obamacare plan” was free. Salazar said he sets people straight as often as he can at the center, health fairs and around town.
“When they hear it's not free, they get over it when they hear about the benefits,” Salazar said. “They just want to get insured.”
But language barriers and misinformation are not the only concerns. He said many Hispanics in poor Miami neighborhoods also are skeptical and concerned about how applying for insurance may affect immigration status for themselves or a member of their family.
Hispanics today account for 4.3 million of Florida's 19 million residents. In 2010, an estimated 825,000 were unauthorized immigrants, according to Pew Hispanic Center Research. Salazar said building trust became critical to reaching the many eligible legal immigrants and encouraging them to apply.
Immigrants need intentional, culturally relevant education about the health insurance exchange in a language they are most comfortable with, said Jodi Ray, director of the University of South Florida's Covering Kids & Families program, which is responsible for signing up uninsured residents statewide.
Ray said she has seen licensed navigators and certified application counselors at her Tampa office helping residents in Spanish, Creole, even Arabic. After spending 15 years enrolling the state's children for insurance, she knows the value of relating to people in a way they understand.
“You become that trusted person … and that's what you have to do,” she said.
Also, these barriers only magnify other problems that have cropped up since the Oct. 1 rollout of the federal insurance exchanges and their beleaguered website, www .healthcare.gov. The website lets low- and middle-class individuals who are uninsured or who buy their own insurance compare commercial health plans and determine whether they can earn subsidies on monthly premiums.
Application counselors and navigators say immigrants eligible to buy commercial health plans on the exchange also are frustrated by an application process that has been slowed by countless breakdowns on the website. Eligible applicants include immigrants with legal documents, such as a green card or student visa.
“I don't want them to get so frustrated that they will give up,” said Josephine Mercado, executive director of Hispanic Health Initiatives, which targets 500,000 Hispanics in Orange, Osceola, Seminole and Volusia counties.
Many of her clients are here legally and work low-wage jobs in Central Florida's tourism industry. The health exchange is the only way they can afford health insurance because they are eligible for subsidies on policy premiums. Without insurance, they will continue to avoid health care, unless they are in an emergency.
Salazar works at Miami's Jesse Trice Community Health Center, where more than half of the 32,580 patients this year have no insurance at all. Another 29 percent already are signed up for Medicaid, the government-backed health plan for poor children, pregnant women and the disabled, said Annie Neasman, the center's chief executive officer.
In October, counselors helped 385 clients at the center complete insurance marketplace applications for themselves and their families. Of those, 117 were done on paper, and more than the 113 were complete online. Another 155 applications were done for Children's Health Insurance Plan (CHIP) programs.
“We're speaking in layman's terms. We're speaking at their level,” said counselor Mylerne Charles, who works with clients who speak Haitian Creole.
Mercado said residents she speaks with are determined to get insurance and know enrollment lasts until March 31. She suggests they avoid logging onto the website until December, when she hopes the glitches will be gone.
“We have this calamity. I hope it will get straightened out,” Mercado said. “I think it will.”