Andrea Velandia, 29, is just the sort of person the architects of the new health insurance marketplaces had in mind when they were thinking about future customers.
She's young, in good health, uninsured and Latino.
"We're very healthy. We don't have many issues," she says of her family. For the most part, she and her husband avoid the health system. "It's very expensive to go to the doctor to get a regular checkup," she says. "And you only have an option to go to the emergency room, which is even more expensive."
On Oct. 1, Velandia, who is from Colombia, will be able to sign up her family of four for a subsidized health insurance policy in the new Maryland Health Benefit Exchange, the state's online marketplace for insurance policies created under the Affordable Care Act.
And just as Latinos were crucial to President Obama's re-election in 2012, they are now key to the implementation of his health law.
The administration has made clear that the health law will succeed only if Latinos, like the Velandias, enroll. And it's pulling out all the stops to make sure they do. Health and Human Services Secretary Kathleen Sebelius will be making the rounds on Spanish-language media outlets to discuss the health law and the newly revamped CuidadoDeSalud.gov, the Spanish version of HealthCare.gov.
Their youth is important for the insurance pools to work. Young and healthy people need fewer medical services, and insurance companies can use their premiums to help subsidize coverage for older or sicker patients.
On a recent morning, Velandia visited the legal clinic at the nonprofit community organization Casa de Maryland in suburban Washington to get help filling out the last bit of paperwork to become a U.S. citizen. Sitting patiently with her toddler and newborn, she was approached by one of the center's promotoras — lay health promoters who help spread public health information in the Latino community. The woman offered Velandia information about breast cancer, healthy eating and diabetes.
In just a few months, Casa de Maryland's 20 promotoras will be expanding their outreach to include information on signing up for a new health insurance policy as well. The organization recently received a special grant from the state to help Latinos and other immigrants sign up for the exchange.
George Escobar, Casa de Maryland's health director, says he plans to use the grant to train his promotoras and hire a dozen new employees to work full time on enrollment.
Jennifer Ng'andu, who heads the health and civil rights policy project at the National Council of La Raza, says Latino organizations have their work cut out for them. The congressional health care debates of 2009 and 2010 created a sense of distrust in the community, she said, because there was a focus on how to keep undocumented immigrants from using any of the benefits under the health law.
"The takeaway often was that there isn't really anything in the Affordable Care Act for the Latino community," says Ng'andu. "Many people forgot to talk about the fact that there are a broad set of Latinos who are lawfully present and who will gain the benefits of the Affordable Care Act."
She adds that the current congressional debate about overhauling immigration is adding more fear and confusion, especially in families where some people are citizens and others aren't.
On a recent trip to California, Obama highlighted an outreach campaign targeting Latinos that he says should be replicated in other states. Hispanic media groups Univision, Telemundo and ImpreMedia are publicizing the exchanges in a campaign on television, radio, mobile platforms and the Web. The administration says it could reach nearly 100 percent of Hispanic families in California.
The message will also reach the millions of undocumented Latino immigrants — but the law bars them from purchasing insurance on the exchanges, even with their own money.
Back in Maryland, George Escobar says the job of people promoting the exchanges doesn't end with enrolling people who qualify. The advocates also need to help those who can't use the exchanges find other options for care.
ROBERT SIEGEL, HOST:
This week, the Obama administration announced an effort to promote the new health insurance marketplaces to Latinos. Health and Human Services Secretary Kathleen Sebelius will make the rounds on Spanish-language media. Under the Affordable Care Act, people can start signing up to get insurance through the marketplaces on October 1. Some 10 million Latinos could gain coverage. Advocacy groups are trying to help Latinos sign up, as we hear from Jenny Gold in Maryland.
JENNY GOLD, BYLINE: It's a crowded morning at the legal clinic at CASA de Maryland, a nonprofit in suburban Washington serving the local Latino community. Elva Jaldin makes the rounds with her clipboard and health pamphlets. She's one of the center's 20 (foreign language spoken), health promoters who help explain things like vaccinations and diabetes to anyone coming in.
ELVA JALDIN: (Foreign language spoken)
GOLD: Today, she's telling women about breast cancer risk. Soon, she'll also be telling people like Andrea Velandia how to sign up for health insurance under the Affordable Care Act. Velandia is at CASA de Maryland with her toddler and newborn for help finishing her citizenship papers. Right now, like many Latinos, she's young and uninsured.
ANDREA VELANDIA: I just think it's very expensive to go to a doctor to get a regular checkup, whatever you are doing, a test or anything. It's just a lot of money. And you only have an option to go to the emergency room, which is even more expensive, I guess.
GOLD: So far, she's been able to make do.
VELANDIA: We're very healthy. Like, we don't have, like, many issues.
GOLD: And that makes her just the sort of person Obamacare needs most. The more young and healthy people who buy insurance in the new marketplaces, the less insurers have to pay in claims and the lower premiums will be. And so the state gave CASA de Maryland a grant to hire a dozen new employees called navigators to work fulltime on enrollment in their centers. Here's health director George Escobar.
GEORGE ESCOBAR: Plus we'll have navigators, basically mobile navigators that will be working in the community, that will be enrolling - educating and enrolling people in businesses, at supermarkets, at community events, weekends, evenings.
GOLD: It may not be easy. The debate over the Affordable Care Act a few years ago focused largely on Latinos who are not eligible: undocumented immigrants. Jennifer Ng'andu works on health policy at the National Council of La Raza.
JENNIFER NG'ANDU: So the takeaway often from that public message was there isn't really anything in the Affordable Care Act for the Latino community. Many people forgot to talk about the fact that there are a broad set of Latinos, in fact, most who are here lawfully present and who will gain the benefits of the Affordable Care Act.
GOLD: She says the current debate over immigration reform is adding more fear and confusion, especially in families where some people are citizens and others are not.
NG'ANDU: Even if everyone in that household is legal, they still have different eligibility from each other. And so teasing all of that out can be difficult.
GOLD: In California, Spanish-language media are proving to be a key part of the push. The California Endowment, a foundation based in LA, is sponsoring a series of ads on Spanish networks Univision, Telemundo and ImpreMedia. One of them features celebrity psychologist Doctora Isabel.
(SOUNDBITE OF ADVERTISEMENT)
DANIEL ZINGALE: Dr. Isabel's ad is a good example of how you have to tailor the message for the audience.
GOLD: Daniel Zingale runs the endowment's outreach campaign. He says it's not enough just to translate an English ad into Spanish. You also have to address the cultural differences. He points to an ad in English featuring Dr. Oz.
(SOUNDBITE OF ADVERTISEMENT)
ZINGALE: In the Dr. Oz ad, he speaks in language that's very familiar to those in mainstream English language press, but in the Spanish language ad with Dr. Isabel, she describes Obamacare as a blessing and we learned early on that that was language that was appropriate to that audience.
GOLD: That message will also reach the millions of undocumented Latino immigrants. But the law bars them from purchasing insurance on the exchanges. CASA de Maryland's George Escobar says their job is not only to enroll people who do qualify, it's also to help those who don't find other options for care. For NPR News, I'm Jenny Gold.
SIEGEL: Jenny Gold is with our partner Kaiser Health News, a nonprofit news service. Transcript provided by NPR, Copyright NPR.