Under fire for a shortage of Latino sign-ups for Obamacare, the state's health insurance exchange is looking for a booster shot from a well-established Southern California clinic chain.
One recent weekday, Maria de Lourdes Martinez sat at a cubicle inside an AltaMed enrollment office in East Los Angeles browsing through the health plans available under the Affordable Care Act. Martinez, 49, of Rosemead, came to this strip-mall storefront across from a Starbucks because she'd brought her grandmother to an AltaMed clinic before.
"It's familiar," she said.
That's a big reason why AltaMed, a network of nonprofit clinics dotting Los Angeles and Orange counties, has been able to sign up about 900 people a week for Obamacare coverage, state officials say.
Much of the activity is centered at its two enrollment offices in East L.A. and Santa Ana, where people often line up in the morning before the doors open at 8 a.m. Overall, AltaMed has nearly 120 enrollment counselors. Health plan sign-ups end March 31, and enrollment doesn't reopen until November.
The clinic's roots go back 45 years, and it has become a trusted name in the communities it serves. "We're not a Juanito-come-lately," said Castulo de la Rocha, AltaMed's chief executive.
In contrast, the state's Covered California exchange remains a relative unknown to many consumers. It has made matters worse at times from missteps in marketing to the state's large Latino community.
For instance, the state didn't publish a paper application in Spanish until three months into open enrollment, and it faces a shortage of Spanish-speaking call-center workers and enrollment counselors in local neighborhoods. Its initial TV ads geared to Latinos suffered from poor translation and struck many experts as dull and too full of insurance jargon.
With the March 31 enrollment deadline fast approaching, Covered California has increasingly sought to piggyback on the local currency of AltaMed to remedy its low turnout among Latinos. It's a crucial population because Latinos represent 60% of the state's uninsured residents. And many of them are young and relatively healthy, a key group to help offset the costs of insuring older, sicker enrollees who flocked to the exchange early on.
AltaMed "is on the cutting edge of showing you what you can do in a community when you reach out to families, to communities, to get them enrolled," said Peter Lee, Covered California's executive director. "Thousands of people are signing up because of their efforts."
California has made some modest progress with Latinos after a slow start. It launched new Spanish-language TV ads featuring recent enrollees. It recruited labor activist Dolores Huerta, co-founder of the United Farm Workers alongside Cesar Chavez, to record online and radio ads imploring working-class Latinos to get coverage.
Last week, the exchange said that 22% of health plan enrollees through February identified themselves as Latino on their application. That was virtually unchanged from January results. Nearly half of the 2.6 million people eligible statewide for federal premium subsidies are Latino.
Rep. Loretta Sanchez (D-Santa Ana) has welcomed California's renewed efforts, but she said the outreach to Latinos still isn't good enough.
"While the number of Californians who have enrolled in quality, affordable healthcare is impressive and far exceeds the rest of the nation, there is much to be done before the March 31 deadline," Sanchez said.
At the AltaMed office in East L.A., families sit with enrollment counselors in small cubicles for 30 minutes to an hour filling out an online application. They sift through pay stubs, immigration papers and other important documents. Statewide, there are relatively few full-time retail locations where people can walk in any time to get help.
AltaMed got its start as the East Los Angeles Barrio Free Clinic in 1969, and it has grown to more than 40 clinics across Southern California. AltaMed serves more than 180,000 patients and is one of the largest nonprofit federally supported health centers in the country. For the year that ended in April 2012, its revenue grew 15% from the previous year to $232 million.
Despite its long experience with government health programs, AltaMed said it wasn't easy gearing up for exchange enrollment. Like many community groups and organizations, it ran into delays with the state getting enrollment counselors trained and certified on time.
"This has been more difficult than we expected," said de la Rocha, AltaMed's CEO. "Big transformations like this don't always run smoothly."
Carmela Castellano-Garcia, CEO of the California Primary Care Assn., said community health centers such as AltaMed employ about a third of the 4,900 enrollment counselors statewide.
She said AltaMed and Clinica Sierra Vista are among the state's biggest enrollment operations. Clinica Sierra Vista said it has about 30 clinics in Kern, Fresno and Inyo counties, and has been doing about 600 applications a week with 45 enrollment counselors.
This historic expansion of health insurance offers a financial opportunity for AltaMed as well. Some current patients who pay a reduced fee at its clinics based on their income will gain comprehensive medical insurance, which will offer higher reimbursement for care.
In addition to signing up current patients for insurance, AltaMed is looking to acquire new ones through the healthcare law. Major health plans such as Anthem Blue Cross, Health Net Inc. and L.A. Care include AltaMed as part of their provider network on exchange policies.
Martinez, the Rosemead resident who was recently at an AltaMed office, was shopping for a policy cheaper than her current Kaiser Permanente plan. She has been paying $800 a month for her family of three.
The AltaMed enrollment counselor found a Health Net plan that would cost her family about $200 a month, after accounting for a premium subsidy.
Even with the lower rate, Martinez wasn't ready to enroll and wanted to think it over before March 31, she said. "I want to pay as little as possible."