Hispanics a tough sell on healthcare reform

Hispanics A Tough Sell On Health Care Reform
As A Group, They're Among The Most Likely Not To Have Coverage, But They're Wary Of Current Reform Efforts
By Niraj Chokshi, National Journal, August 24, 2009

As one of the least likely demographic groups to have insurance, Hispanics might be expected to have high hopes for the current reform efforts. Yet, more than any major demographic except Republicans, they expect an overhaul to worsen their situation.

In the nearly two dozen congressional districts with a Hispanic majority, the number of people with health insurance is 16 percentage points below the national average, according to a NationalJournal.com analysis. Hispanics accounted for 15 percent of the nation's population in 2007, but 32 percent of the nation's uninsured.

And in a Gallup survey of tens of thousands of adults this June, 42 percent of Hispanics said they were uninsured, a higher percentage than any other demographic by race, age, gender, region or economic status. The next most likely group to lack coverage -- adults making less than $36,000 -- had an uninsured rate of 29 percent.

"One of the most underserved constituencies in America is the Latino community," said Rep. Raúl Grijalva, D-Ariz., the co-chairman of the Congressional Progressive Caucus and a member of the Congressional Hispanic Caucus.

At the same time, Hispanics are more pessimistic about the current legislation than most, according to the results of a Marist poll of nearly 1,000 people released Aug. 14. When asked what impact passage of health care reform would have on themselves and their families, 41 percent of Hispanics said their situations would get worse. That percentage is the highest among all demographic groups -- by region, income, education, age, gender or households with children -- except Republicans, 54 percent of whom responded in kind.

"[There's] kind of this resignation that nothing will change," Grijalva acknowledged. His answer, and that of the congressional progressive and Hispanic groups, is a public option. Without it, "you've tied our hands; we don't have anything to sell to our community."

Leslie Sanchez, a political analyst and former Bush adviser, says there's a split between Hispanics whose families have been in the country for generations and are more concerned with cultural issues, and those who immigrated more recently and are more concerned with economic challenges. Sanchez expected the Obama administration’s and congressional Democrats’ reform efforts to play better with the latter group, while the former would be more open to Republican arguments.

"As much as we like to talk about the ‘Latino vote,’ it doesn't really exist because it's not monolithic," she said.

John Andrade, the Hispanic founder of Houston-based advertising firm Andrade Design, embodies the conflicting need for and doubt over health care reform. When he was picking out a family health insurance policy, it cost too much to cover his whole family, so he insured his wife and children but not himself. Now, he's looking to secure insurance for his five employees, something he hasn't been able to do because of high costs.

But while Andrade says reform is needed, he has little faith in a government-run health care option. "I don't think the government can take on that kind of responsibility, especially in the economic situation we're in," he said.

Nevertheless, advocates of health care reform are reaching out. On Aug. 16, the White House introduced "La Realidad," the Spanish-language version of its “Reality Check” Web site, the goal of which is to provide facts about the legislation. Meanwhile, the National Council of La Raza is embarking on a major campaign to mobilize voters behind reform.

"We're asking people to say why we need health care reform to reach our communities and families," said Jennifer Ng'andu, deputy director of the health policy project at NCLR. The group has set up dozens of meetings with congressmen and is encouraging Hispanics to attend local town halls. It’s also distributing 15,000 postcards during the August recess so Hispanics can share their stories with elected officials, targeting key states such as Montana, Connecticut, California and North Carolina.

The Republican National Hispanic Assembly, which identifies itself as "the only Hispanic Republican organization recognized as an ally of the Republican National Committee," did not respond to calls for this report.

Complicating matters for groups favoring reform is the fact that immigration -- an issue of special concern to Hispanics -- has become entwined in the debate. Opponents of the current reform effort say the legislation would fund health care for illegal immigrants, an allegation President Obama dismissed during his appearance on right-leaning radio host Michael Smerconish's talk show last week.

For their part, NCLR and Grijalva have stressed the plight of legal immigrants in their pro-reform rhetoric. One specific goal both are pushing for is a lift of a five-year waiting period for immigrants on receiving certain government benefits such as Medicare and Medicaid. "You're punishing somebody for going through the process of becoming legal," Grijalva said.

A plurality of uninsured Hispanics surveyed by the Pew Hispanic Center in 2007, 37 percent, said they lacked health insurance because it was too expensive. Eighteen percent cited "some other reason," and the remainder cited reasons such as not qualifying for employer-based coverage (9 percent), not knowing how to get insurance (8 percent) and being restricted by their immigration status (8 percent). Ng'andu pointed to a low rate of employer-sponsored health care across economic class among Hispanics. According to 2007 census data, 20 percent of Hispanics making over $75,000 a year were uninsured. The rate for whites making less than $25,000 a year was 19 percent.

Andrade said part of the problem may also be cultural. His father-in-law, he says, is often reluctant to seek medical care. "If you go to the doctor, either you're weak or you could get sick or it's just bad luck to even think about," Andrade said.

His friend Lionel Sosa, a Hispanic media consultant on seven Republican presidential campaigns, agreed.

"Men are very macho,” he said. “They'll wait until they're dead before they go to the doctor."