Hispanic and Latino health and the Affordable Care Act

As a little girl, I would accompany my immigrant mother to her numerous doctor’s appointments; I didn’t know it, but at the time, she was fighting a brain tumor. By the tender age of 7, I had translated most medical terminology from English to Spanish; see, my mother did not speak any English and when she went to the doctor’s office, I was her tiny translator, not that I knew much, but I tried my best.

By the time I was 13, I understood what was happening to my mother and knew how to discuss her symptoms with all her physicians, including neurologists and radiologists. I had my mom buy me a Spanish-to English medical dictionary and became well-versed in the processes that happen at every one of my mother’s appointments: blood pressure check, weight check, neurological tests. When I moved out of my parent’s home at the age of 24, she stopped going to her doctor’s appointments regularly and chose which doctors she “felt” like going to at the time. I have heard all of the excuses in the book: “I don’t know if they will have an interpreter,” “I feel fine, why do I need to go?” and the most recent one, “I don’t have the money to go to the doctor.”

Related: 10 states where consumers are more likely to skip the doctor due to cost

Interestingly enough, I am not the only daughter of immigrant parents that has heard these excuses; Latinos are the second-fastest-growing racial and ethnic group in America. I am sure there are other first-generation children out there who have had to learn how to translate for their parents at various doctors’ appointments. The entire population suffers from poor health and is less likely to have access to quality health care. One in two Latinos will develop diabetes over their lifetime; and once they are diagnosed, they have worse outcomes than non-Hispanic whites. Health and health care are a two-way affair: poor health care leads to poor health, and poor health leads to more expensive and less accessible health care.

Barriers to health care

“Typically, Hispanics are more likely to be employed in agriculture, construction, food and domestic services and retail trades, which are less likely to have benefits offered to their employees.”

The language barrier poses a big concern for most Hispanic patients. Most Latinos and Hispanics prefer Spanish-speaking physicians over non-Spanish speaking physicians. They also prefer visiting a medical facility or hospital that promotes a diverse staff; this tends to make Latinos feel more at ease and less likely to feel threatened or discriminated against. Availability of translators and Spanish-speaking staff is usually a factor for most Latinos to obtain consistent primary care.

Historically, lack of health insurance has been a major problem for Hispanics, who are typically more likely to be uninsured when compared to non-Hispanic whites. Rates of being uninsured vary across different Hispanic subgroups; Mexican, Central and South Americans tend to be less likely to be insured than Puerto Ricans and Cubans.

Unfortunately, Hispanics are even more less likely to obtain health insurance from their employers, which is the most common source of health coverage. This is usually related to the mere fact that Hispanics tend to work for employers that do not offer health coverage to their employees, and they are less likely to be eligible for coverage even if it is offered to them. Typically, Hispanics are more likely to be employed in agriculture, construction, food and domestic services and retail trades, which are less likely to have benefits offered to their employees.

Hispanics’ primary concern is getting the job, and the second concern is the salary; health insurance is not usually a primary focus for Hispanics when looking and applying for jobs.

Public health insurance programs for low-income people, such as Medicaid, provide many Hispanics with health coverage. Unfortunately, the uncertainty about Medicaid eligibility and risks in enrolling in Medicaid were added to other long-standing barriers to participation in public health insurance programs, such as lack of information and language.4 Citizenship is usually akin to health insurance, and immigrants tend to be less likely to have it.

Early and continuous prenatal care tends to result in healthy outcomes for both mothers and children. Prenatal care is usually the entry point for Hispanic mothers to the health care system in the US, especially for women who do not have a primary source of care. Lack of health insurance makes prenatal care unaffordable for many Hispanic women. Additional barriers are likely to include language and cultural incompatibility between women and their prenatal care providers, lack of understanding or knowledge of prenatal care, and fear of the effect of seeking care on immigrant status.

It has been found that there is a relationship between language preference with having a usual source of care. Working-age Hispanic adults are less likely to have a usual source of care, such as a primary care physician or a community health center charged with maintaining their health care. Lack of a usual source of care is usually attributed to the distance of the medical care facilities and the low availability of Hispanic health professionals. Hispanics believe that Hispanic medical professionals provide a higher quality of care to their own people; as such, Hispanics would travel further distances when choosing a physician if the physician speaks Spanish. It is often perceived, actual or otherwise, that Hispanics are treated worse than others because of their race or ethnicity.

In contrast to European immigrants, Hispanic immigrants continue to base their identity on maintaining the strength in their family ties, culture, religion and, especially, language. Most third- and fourth-generation Latinos still speak Spanish fluently and it can be seen in the growth of Spanish-speaking television and radio programs. Latinos and Hispanics tend to be very loyal to brand names and things they see on Spanish television; which means they tend to spend more money on over the counter medicines than many other minority groups. Latinos and

Hispanics tend to rely more on home remedies and over the counter medications as well as relying on medical advice provided by friends and family members. Latinos tend to self-diagnose and self-medicate and will only seek professional medical advice when symptoms persist. In the Latino community, the woman is considered to be in charge when it comes to medical care concerns in the home; the man often hides medical issues to appear stronger, and only when it begins to affect the family, the woman takes the charge to find a remedy.

How the ACA narrowed the gap for Hispanic people

The Affordable Care Act (ACA) has narrowed racial gaps in access to health care, but Latinos are still nearly three times more likely to be uninsured than non-Hispanic whites. African Americans and Latinos had the highest uninsured rates when the law went into effect in 2010 and have made the largest gains since. The coverage made it easier to obtain health insurance, as adults with low income have benefitted from the low subsidies, out-of-pocket cost protections and the expansion in Medicaid eligibility.

The ACA provided states the opportunity to expand eligibility for Medicaid with the federal government picking up most of the additional cost. The 31 states that expanded their eligibility showed less disparity amongst their African American and Latino populations and reported less uninsured rates.

Unfortunately, these gains in the health care world have stalled and ultimately eroded. Latinos are once again less likely to be insured due to the erosion of the ACA.4 Latinos fear the public charge rule, immigration status, and deportation and as a result refuse to obtain coverages available to them. Increasing costs of health care also tends to be a huge barrier to access to quality health care.

In 2018, a Texas judge ruled the individual mandate of the ACA is unconstitutional, and the judge struck down the entire ACA. A U.S. Circuit Court affirmed the ruling and is now under review by the U.S. Supreme Court in the 2020 session, see Texas v. United States6. A judicial repeal would cause the loss of health coverage for 5.4 million Latinos.

The 2020 election and Latinos

“As a daughter, it is frustrating to know that there are resources to help out our parents obtain better quality care, but in order to obtain them, you will need to guide your parents, translate the resources and steer them in the right direction.” 

These past eight years have been a roller coaster for health plans with the enactment of the ACA, the individual mandate, and the Trump administration attempting to repeal multiple parts of the ACA. Even though the Texas case gets heard in the Supreme Court in the Fall of 2020, an opinion will not have been released until May or June 2021. At the time of this article, the only thing we can do is speculate with how the next year or so will play out.

At this time, the media is reporting that Joseph Biden is our new president-elect, and until the Electoral College makes the final vote on December 14, 2020, we will not know who the next President of the United States will be. We can bet that if Joseph Biden does indeed get into office, the ACA will more than likely be left intact, and better yet, expanded to included immigrants as it was proposed in the Health Equity and Access under the Law (HEAL) Act. This Act would remove the five-year bar that immigrants have to wait to obtain any Medicaid and it would provide undocumented immigrants the opportunity to purchase health insurance from the Marketplace made available by the ACA. With the COVID-19 pandemic, the federal government will end up paying for treatment and eventually will push to have everyone in the country vaccinated, including undocumented immigrants.

In the meantime, there should be a push for policies for better Latino health, such as a national tax on sugary beverages; this could begin to curtail the diabetes epidemic suffered by Latinos. Some communities have also created programs to provide community health workers to promote good health. These programs provide Spanish-speaking social workers educated on services available to the community and can coordinate obtaining appointments and scheduling interpreters available to them. Other communities have also begun to educate on better health practices in public schools to students.

As a daughter, it is frustrating to know that there are resources to help out our parents obtain better quality care, but in order to obtain them, you will need to guide your parents, translate the resources and steer them in the right direction. My mother is still under the care of a physician and she chooses when she “feels” like going especially if she is not experiencing any symptoms. She has been diagnosed with pre-diabetes, and we are working together to change her habits to prevent it from developing into full-fledged diabetes.

As an employer, beginning to understand how your Latino employees perceive health care can help you keep your Latino population healthy. For example, having a Spanish-speaking person in your HR department that is educated in the health benefits you offer and become a promoter for better care.

Maribel Echeverry McLaughlin, Esq., is a subrogation attorney with The Phia Group, LLC. Maribel concentrates on subrogation and reimbursement, and she handles many challenging and complex recovery cases.