Expand literacy, improve health care

Following the 6-3 Supreme Court ruling on the Affordable Care Act, the 316,541 Georgia residents who purchased health insurance in the ACA marketplace can breathe a sigh of relief. Tax credits for qualifying individuals who enrolled through Georgia’s marketplace are here to stay. Of those enrolled, 89 percent qualified for tax credits.

Free from the uncertainty that the recent ruling might undermine one of the key provisions of ACA, community organizations can now focus on providing education and enrollment services to the many Georgians who remain uninsured. The provision of culturally competent outreach and education services should be of utmost priority, integrated through all steps of the ACA enrollment process.

Our research found successful enrollment services must begin with basic health literacy. Too many Americans still don’t understand the jargon — co-pays, deductibles, premiums — associated with health insurance. Increased insurance knowledge is a prerequisite for determining which plan to choose. Without this knowledge, consumers face frustration as they weigh various plans.

Understanding technical insurance language is not the only challenge. For some, language itself is a barrier. During the initial enrollment period, there were only three Spanish-speaking navigators — ACA enrollment assistants — in the entire state. As a result, only 4.73 percent of Georgia’s eligible uninsured Latinos enrolled in a marketplace plan, according to the U.S. Department of Health and Human Services.

But these enrollment numbers are not reflective of need. In Georgia before the ACA, almost half (44 percent) of Latinos lacked insurance. Our research showed Latinos preferred to enroll during a face-to-face session with an ACA navigator. The number of eligible Latinos relative to the dearth of Spanish-speaking navigators makes fulfillment of that preference nearly impossible.

Latinos are the least likely ethnic group to visit a doctor or utilize health care services. Given that most Latinos are young adults, increasing Latino enrollment in the marketplaces may actually expand the pool of healthy enrollees — something needed for any insurance system to work.

Some may wonder how Latino under-enrollment is influenced by immigration status. That shouldn’t influence enrollment at all. Undocumented immigrants are not eligible. But Georgia’s 173,000 legal immigrants are, and because there are many legal forms of immigration, it can be challenging to accurately provide immigration status when enrolling. The crackdowns on undocumented immigrants at the same time as the ACA rollout only muddled things further.

The Supreme Court ruling guarantees ACA tax credits will continue. To access the subsidies and other protections the ACA affords, people need to be able to enroll. Providing navigators with basic health literacy information, in addition to information about insurance plans, would be a welcome first step in increasing effective enrollment. Guaranteeing that Georgia has a sufficient number of Spanish-speaking navigators will also support that end, ultimately improving health care access across the state.

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Dabney P. Evans is an assistant professor of global health at Emory University’s Rollins School of Public Health. Audrey McCulloch is a graduate of the Hubert Department of Global Health at Rollins.

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