Thousands of Angelinos each week continue to enroll in California Covered, the Golden State’s version of the Affordable Care Act, but African Americans locally remain just on the fringe of regular health care services, even as the process is being continually tailored to include more persons of color into its ranks.
Officials in Sacramento have struggled since the open enrollment period in November 2013 to enroll more African Americans statewide, opting this second go-around to focus more on Black target areas such as the local church, Black business districts (ex. Crenshaw strip), Black media outlets and just about any entity attracting a primarily large African American clientele.
Covered California has provided grant money to numerous nonprofit groups and organizations active in the Black community for education and enrollment efforts. The exchange has worked with state lawmakers and some labor leaders to further publicize the health care for which many Black families for decades have been without because of a myriad of reasons, among them lack of neighborhood physicians, pre-existing medical conditions, and logistical problems, especially for persons without adequate transportation.
When the first enrollment period ended in March, only 30,774 African Americans had enrolled in Covered California, out of some 370,000 Blacks statewide who may have been eligible for state-run coverage. That low enrollment figure compared to 350,000 White, 253,000 Latino and 211,000 Asian sign-ups by the spring deadline. African Americans had comprised only 2.7 percent of statewide enrollees, despite high hopes that Covered California would sign-up a minimum of 220,000 Black persons.
Statewide, about 17 percent of African Americans are uninsured, though this population comprises approximately 7 percent of California residents. Covered California wants to change these numbers by unleashing a new, target-oriented publicity campaign in which 9 percent of its advertising budget will be directed toward the Black community. Peter Lee, executive director of Covered California, said this fall that the new enrollment campaign promises to give more focus to reaching historically undeserved communities.
“We’re looking at other data to see where we did a great job or not so great of a job,” Lee said. “Within Covered California about 5 percent of subsidy-eligible people are African American. About 4 percent of our enrollment last spring was African American, so we definitely want to lean in and double down. If you look at the Navigator Grants (used for community outreach, education and enrollment) we specifically looked out and said ‘who can we add’ who is anchored in the African American community that can show they know that community and can reach out effectively and bolster education and enrollment efforts.”
The new marketing campaign is featuring more television, online, radio and print advertising specifically designed to attract more minority participation. Among the new outreach services are the Education Grant Program which promotes awareness among consumers and small businesses by way of informational tools designed to refer the individual and/or small business to available resources. The Navigator Grant Program provides money to community groups which, in turn, assist in the statewide advertising campaign to attract new customers. This includes $46 million in advertising statewide, $14.6 million for community outreach, and these community groups are expected to spend another $33.4 million in outreach campaigns by the end of the February 2015 deadline. An enrollment assistance program, consisting of both enrollment entities and enrollment counselors, provides “in-person” help to consumers find the optimum form of coverage.
The Community Outreach network is composed of community-based organizations, stakeholders and individuals who have partnered with Covered California to promote locally the value of health care coverage, and to “change attitudes” and to remove any and all barriers to enrollment.
Small Business Health Options offers “webinars” for small business owners who may have similar products, payroll and management characteristics.
The Certified Insurance Agents program provides training and certification to insurance brokers to issue policies to individuals and to small businesses.
The Navigator Grant program has resulted in tangible benefits for urban access to Covered California. Brownell Payne, M.D., operates Crenshaw Health Partners and said that while Covered California enrollment of southland African Americans has been disappointing, the number of persons he sees on Medi-Cal may demonstrate that health care coverage is given strong consideration in the Black community. Crenshaw Health Partners this spring received a Navigator Grant valued at $300,000.
“When we talk about enrollment among African Americans, we’re not exclusively discussing Covered California, but rather Medi-Cal,” Payne said. “In the area where we operate, a significant portion of our community has Medi-Cal and these numbers have been huge.” Payne said that with every insurance enrollment his medical office makes in the African American community, at least “two to three” people are enrolled in Medi-Cal “because many people don’t know that they’re eligible.” Payne also said “misinformation” may be a factor that prevents many African Americans from joining Covered California.
Old myths about government control/surveillance of privacy (ex: so-called monitoring “chips” inserted under the skin, in the brain, etc.) actually come up during some conversations about government-sponsored health care services. “We’ve had people come up and say ‘we’re not going to enroll in Obamacare because they put a chip in your wrist, and they can track you for the rest of your life.’” Payne said he would like to see more organizations which receive Navigator Grants focus more on practical issues such as “communicating the merits of insurance” to people who have never had on-going health care coverage.
Since many African Americans in urban communities do not have a personal insurance agent—nor do many have home access to a computer—the onus of enrollment has fallen onto service centers and/or counselors. The one-year rollout of Covered California has seen insurance agents account for 40 percent of enrollment; individuals via home computer have accounted for 41 percent of sign-ups; service-center representatives and certified enrollment counselors have each comprised 9 percent of enrollment, and county eligibility workers (social workers) have tallied 1 percent of enrollees.
California’s attempt to increase Spanish-language marketing may have diminished outreach to other minority groups, says Carla Singleton, a marketing manager for L.A. Care. “From Covered California all the way down,” she said, “there just hasn’t been a lot of outreach in African American neighborhoods.” “She said that access to timely medical care could improve the lives of many Blacks who may suffer disproportionately from diabetes, heart disease, hypertension, HIV/AIDS and other chronic conditions.
The Centers for Disease Control and Prevention (CDC) in June 2013 reported that 30 percent of Latinos and 19 percent of non-Latino Black persons were uninsured. That is significantly more than the percentage of non-Latino Asians and non-Latino Whites (9 percent) who were uninsured. The CDC also found that Latinos and African Americans were more likely than Whites to have “failed to obtain needed medical care due to cost.” Also, Latinos and African Americans were more than 10 percent less likely than Whites and Asians to be in “excellent or very good” health.
Refusal of some states to accept the law’s optional Medicaid expansion has reportedly set back progress to provide health care to disadvantaged people. A Kaiser Family Foundation study from December 2013 (“The Impact of the Coverage Gap in States Not Expanding Medicaid by Race and Ethnicity)” revealed that 2.5 million persons of color fall into the “coverage gap” in 27 states that decided not to expand Medicaid, but are below the income level necessary to qualify for subsidies to purchase private insurance on the exchanges. Poor, uninsured African American adults nationwide are particularly affected, the study reported, by the resistance of some states to expand Medicaid and adopt measures outlined within the ACA.
There are a number of Covered California enrollment opportunities scheduled through February 2015:
—White Memorial Hospital, 1720 E. Cesar Chavez Ave., East Los Angeles, 9 a.m. to 3 p.m., on Dec. 19;
—Wesley Health Center, 3591 Imperial Highway, 9 a.m. to 1 p.m., Dec. 20;
—Downey Clinic, 8530 Firestone Blvd., Downey, 9 a.m. to 1 p.m., Dec. 23;
—Woodcrest Elementary, 1151 W. 109th St., Los Angeles, 9 a.m. to 1 p.m., Jan. 24, 2015;
—Caroldale Elementary, 22424 Caroldale Ave., Carson, 9 a.m. to 1 p.m., Jan. 24, 2015.
