On a sunny, cold Sunday in November, Victoria Laverde walked up to an information table at Plaza Las Americas in Lilburn and asked for federal help in signing up for health insurance under the Affordable Care Act.
It’s exactly what officials under the Trump administration hoped would happen when they made big changes to funding for ACA navigation. The government has made news as it stripped down the grant money, reducing Georgia’s enrollment navigator funding to $499,995, down from $1.4 million last year and $3.7 million in 2016. It’s virtually eliminated advertising, and it fired the major statewide nonprofits that used to be navigators. But with the remaining money, it made a bold choice.
Now, under the blessing of the Trump administration, Georgia’s navigator is a group that focuses on immigrants, and strongly on the Latino population.
The administration has now directed navigators to target populations “left behind” by previous marketing for the the ACA, also known as Obamacare. Hispanics, who make up 9.6 percent of Georgia’s population, remain the least-insured major American ethnic group. And Latinos in Georgia, according to 2016 U.S. Census Bureau figures, are more likely to be uninsured than they are in any other state.
Georgia Refugee Health and Mental Health, the new and only statewide navigator, has long been an ACA navigator organization in the past, but never with this much money or this much focus on the Hispanic population. This year’s grant more than triples what the federal government budgeted for the group last year. It exceeds by more than $100,000 any grant it ever received for navigation, even in the flush Obama years. In addition to its focus, Georgia Refugee Health and Mental Health is expected to do the job previous navigators did with the entire state population
The director in charge of the group says the strategy is working.
“People are making appointments both in English and in Spanish and wanting information,” said Kathleen Connors, the director of GRHMH and its new navigator arms, ObamacareParaLatinos.org and HealthCareGA.org.
“I had wanted to move into the Hispanic community,” she said on the day she first learned her organization was awarded the grant. “Millions of dollars have been spent in the state of Georgia. The people who were supposedly doing it weren’t making a dent.”
Whether the Latino population here was really “left behind” may depend on perspective. The rate of uninsured Hispanic people in Georgia is still very high, at 27 percent as of 2016. But that’s down from 44 percent in 2013, the year the ACA kicked in, according to the Kaiser Family Foundation.
“I don’t know what the term ‘left behind’ means,” said Samantha Artiga, a researcher on Latino enrollment at the Kaiser Family Foundation. Across the nation, “the uninsured rate for Hispanics significantly dropped,” she said. But, she added, they were starting from a significantly higher uninsured rate, so they’re still left with a long ways to go.
To be sure, the problem is not eligibility. Of those uninsured Hispanics, nearly half are U.S.-born citizens. Many more are naturalized citizens or have met requirements through their residency.
Everyone who spoke for this story who has worked with the population said the reasons for the lag are many and strong.
“The people need to know what this insurance is about,” said Liseth Fernandez, a navigator at that information table at Plaza Las Americas. “Sometimes Latin people are behind because they don’t speak English. Or people may think it’s not true” — a scam — “or think it’s too expensive.”
Those are things navigation, especially in a person’s native language, can fix.
But another big reason, they said, was fear that an eligible person applying would lead to that person’s relatives being targeted in case they’re unauthorized immigrants.
That’s not supposed to happen, by federal rules, officials said. But the current administration’s focus on immigration has raised fears even for citizens and those here legally, they said. That ramped up after the administration proposed an order penalizing immigrant applicants if they took federal benefits they shouldn’t.
“Even though there are policies in place” to prevent one family member’s insurance sign-up from being used to track down another, unauthorized family member, said the researcher, Artiga, “I think there’s just so much fear and uncertainty — and it’s really ramped up — that I think families are just really wary of participating.”
Fred Ammons, who heads Community Health Works, the parent organization of the previous statewide navigator in Georgia, Insure Georgia, said it had made an important dent in the Hispanic uninsured population before it lost the grant this year. But the population includes people with specific challenges for health insurance, such as people who migrate from state to state for farm work, which makes insurance enrollment a mess. He notes that “dreamers,” people who were brought illegally to the U.S. as children but were raised here, are not eligible for ACA coverage even if they pay full price without subsidies.
For Laverde, an office worker, that’s not a problem. The Marietta resident is a U.S. citizen who spent years in her family’s home country of Colombia and just returned here in July. She tried enrolling on the federal marketplace website, healthcare.gov, directly but found it “crazy” and confusing. She was relieved to find the navigators’ table because she’s uninsured right now and is glad it won’t stay that way.
“It’s horrible. It’s very scary,” she said. “I have a 12-year-old. It’s really, really weird that you don’t have protection just for emergencies.”
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