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Latinos are focus of grass-roots outreach on Affordable Care Act

Elizabeth Ramos, a community health worker with QueensCare Health and Faith Partnership, checks the blood pressure of Anna Ovalle, 53, at La Placita Church in Los Angeles.
(Genaro Molina, Los Angeles Times)

Standing just inside a busy Baldwin Park supermarket that caters to Latinos, Moises Herreros smiles as he flags down shoppers. “Do you have insurance? Do you have any questions about Obamacare?”

Many stop to chat in Spanish. They’ve heard of the health law but don’t know how it works.

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In a state where Latinos make up 60% of those without medical insurance, that lack of awareness is a pivotal challenge facing health officials charged with rapidly educating millions of residents and enrolling them in coverage.

Latinos are the most important constituency in California’s coming healthcare transformation. But many know little or nothing about how it will work or whether they will be eligible for free or subsidized coverage. To get the word out, unions, health centers and grass-roots groups have begun dispatching bilingual workers like Herreros to connect directly with as many Latinos as possible before the law takes effect Jan. 1.

“Broad-based marketing is only going to get you so far,” said Steven Abramson of Community Health Alliance of Pasadena, which treats thousands of Latino patients at its health centers. “You really need bodies on the ground to complement that and speak to people on a one-to-one level.”

Herreros works for Los-Angeles based AltaMed Health Services, a federally subsidized nonprofit clinic network that recently received one of the state’s largest grants for the Latino outreach effort. Herreros, a marketing specialist, said he has spent years getting to know people in schools, parks, grocery stores and elsewhere.

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“I have developed many relationships,” he said. “I’m familiar with what they are going through.... They trust me.” And AltaMed, he notes, has a 40-year history of providing free and low-cost medical care to the Latino community.

In Baldwin Park last month, Herreros used the grocery store’s loudspeaker to announce free, upcoming health screenings and invite shoppers to ask him about the health law.

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Joe Ruelas, 29, who is uninsured and rarely goes to the doctor, said he didn’t know much about the new options but wanted to learn more. Herreros handed him a flier and jotted down the Web address for Covered California, the state’s new insurance marketplace.

Pushing a cart of groceries, Ana Acevedo approached Herreros and said she had Medicare, but her husband was uninsured. He runs a car repair shop, she said, but has had trouble working because of swollen feet and blurry vision related to diabetes.

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“He may be a perfect candidate for Obamacare,” Herreros told her, giving her his office phone number. If her husband doesn’t qualify for free insurance, he should be able to get help buying his own insurance, Herreros said.

Zulma Mendoza stopped to say that she and her three children, ages 7, 18 and 24, were uninsured. She works at a fast-food restaurant and a retail store but neither provides health coverage. When she gets sick, Mendoza said, she pays for care in cash. She’d heard about the new healthcare law on TV but wasn’t sure if she would be eligible for coverage.

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Herreros briefly explained the law, wrote down her number and promised to call her before enrollment begins. “We are going to help you personally,” he promised.

More than half of Latinos don’t understand the Affordable Care Act, according to a recent survey by Latino Decisions, an opinion polling organization. The percentage is higher among those who speak mostly Spanish, the survey found.

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Officials note that enrolling Latinos, who tend to be younger and healthier than the general population, will be critical to balancing out the increased costs of coverage for older, sicker people. In California, roughly 1.7 million Latinos will be eligible for Medi-Cal coverage and another 1.2 million will be able to buy subsidized health insurance through Covered California. Enrollment runs from October to March, with coverage beginning in January.

“If we cannot get [Latinos] all on board, we may not be as successful as we wish,” said Santiago Lucero, spokesman for the marketplace.

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Covered California is partnering with the California Endowment, which has contributed $25 million to an effort called Asegurate, or Get Covered. The campaign — announced at an event with President Obama in June — will use Spanish-language television and newspapers to get the word out through talk shows, news programs, town halls and social media. Trusted media voices can help clear up confusion and mobilize people to enroll, said Maricela Rodriguez, a California Endowment program manager.

Spanish-language media have close links with the Latino community, said Stephen Keppel, who is heading up the campaign for Univision News. “For many communities, we are the main source of information,” he said. “It’s an extremely complicated law.... We try to break it down to its simplest form.”

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Covered California also has issued $37 million in education and outreach grants, many to organizations with ties to Latino communities and businesses. One of those groups, Vision y Compromiso, operates a network of thousands of community health education workers, or promotores. Executive Director Maria Lemus said the promotores already have strong neighborhood ties and can begin the outreach immediately.

Elizabeth Ramos, a promotora with QueensCare Health and Faith Partnership, was among those attending a recent state-sponsored training session. She will spread the word at churches, including downtown L.A.'s La Placita Church. Latinos “need someone to explain it to them, in their own language and in simpler terms,” she said.

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Officials expect outreach workers to encounter resistance over the cost of insurance, which could be hundreds of dollars a month for some families, as well as a general distrust of government. Complicating the education and enrollment efforts will be families in which children are eligible but parents are not because of their immigration status.

“You get all these immigration statuses in one family,” said David Hayes-Bautista, who heads UCLA’s Center for the Study of Latino Health and Culture. “It’s a very confusing picture.... They are going to be reluctant to enroll.”

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The Obama administration is reaching out to Latinos nationwide, including through a Spanish-language site, cuidadodesalud.gov. Federal officials also have allocated $150 million for community clinics serving urban and rural areas to help enroll uninsured patients. More than 60% of the roughly 3 million patients using such centers in California are Latino.

At the same time, health insurance companies are stepping up recruitment campaigns in the Latino community. At a Cinco de Mayo festival in downtown Los Angeles, Anthem Blue Cross employees greeted potential customers inside a white tent and handed out miniature soccer balls. Parents stopped to snap photos of their children hugging costumed characters from the bilingual “Dora the Explorer” cartoon series. While waiting in line for pictures, families filled out information cards Anthem could use to contact them later.

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“People may have heard about Obamacare, but they don’t know when it all starts or what they are eligible for,” said Robyn Gilson, Anthem’s staff vice president for multicultural marketing, standing nearby.

Leticia Cueto said she was eager to hear more about her healthcare options. Her five children have coverage through Medi-Cal, but she said she pays cash to visit a local clinic for her diabetes. “I’m interested in getting insurance so I can see the doctor more,” Cueto said.

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anna.gorman@latimes.com

Times staff writer Chad Terhune contributed to this report.


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