More Latinos insured in state

Spanish speakers lag in coverage; study authors say resources needed

By Chelsea Conaboy
Globe Staff / August 4, 2011

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Hispanics in Massachusetts are much more likely to have insurance coverage and a primary care doctor than they were before the state’s health insurance overhaul five years ago, but a report set to be released today found that those who speak little or no English lag far behind, with one-third uninsured.

The researchers concluded that English-speaking Hispanics were almost as likely to be insured as non-Hispanic whites, after adjusting the data for differences in factors such as age and income.

But the coverage rate for those who primarily speak Spanish was about 11 percentage points lower.

The study results were based on a 2009 national health survey that included more than 10,000 Massachusetts adults ages 18-64. The study was led by the JSI Research and Training Institute, a nonprofit public health consulting firm in Boston.

The authors said the results point to a need for more targeted programs to help those who do not speak English to navigate the complicated insurance enrollment process, but the most recent state budget eliminated money for outreach efforts largely aimed at Hispanics and other minorities.

Through focus groups and in-depth interviews with Hispanic residents, the researchers found that many said they were confused by enrollment and renewal processes or did not understand what insurance was for because they had come from countries where patients pay doctors directly. The study did not determine the immigration status of residents, but illegal immigrants are not eligible for insurance subsidized by the state.

The study, being published today in the August issue of Health Affairs, says signing up Spanish speakers for insurance is not just a Massachusetts concern. In 2014, most Americans will be required to have insurance under a law signed by President Obama last year.

States with bigger Hispanic populations and fewer community health resources than Massachusetts must develop strategies for reaching Spanish-speaking people, said James Maxwell, lead author of the study and director of research at JSI.

“It’s really a neglected topic,’’ Maxwell said. “Given that such a large percentage of the national uninsured population is Hispanic, it should be a much higher priority.’’

Authors of the 2006 state health law made eliminating racial and ethnic disparities a priority. They created a task force to focus on the issue and set aside money - $2.5 million in each of the past two years - for dozens of community groups that assist people trying get insurance.

But that money was eliminated for the fiscal year that began July 1, and it seems unlikely that the state will restore the funding before the current grants run out in December.

“The national economic crisis has required that states across the country make significant budget reductions,’’ Paulette Song, spokeswoman for the Executive Office of Health and Human Services, said by e-mail.

Song said the state will pursue federal grant opportunities.

The budget cut could cost Evelyn Figueroa her job at the Greater Lawrence Community Action Council, where more than three-quarters of the clients are Hispanic. She walks about 320 people each month through enrollment or renewal of their coverage, connects them with primary care doctors or specialists, and schedules appointments.

Each time a notice of canceled coverage or a request for more information is sent to a client, Figueroa gets a copy. Then she follows up by mail - she sends 50 to 65 letters a day - and by phone.

Though the state provides documents in Spanish, many people cannot make sense of them, she said. They are illiterate or have trouble with the technical language. Others simply get lost in the paperwork or are frustrated by repeat notices that their applications are incomplete.

Much of the terminology was lost on Rafael Henriquez, a 39-year-old Lawrence resident who speaks Spanish. He went to a local health center looking for assistance and was directed to Figueroa. She helped Henriquez, who is Dominican, enroll in MassHealth, the state Medicaid program, and scheduled an appointment with a physician.

When his wife, Elizabeth Javier, and four children arrived in Lawrence earlier this year, Figueroa helped secure coverage for the children. She got Javier on a waiting list for a program to cover legal immigrants who have been in the country for less than five years, and she connected her with a free mammography clinic.

Without Figueroa, Henriquez said in Spanish, “it would have been very difficult.’’

Today’s study, using unadjusted figures, found that about 88 percent of Massachusetts Hispanics who chose to answer the survey questions in English had insurance coverage in 2009, up from 78 percent in 2005. Of those who chose Spanish, 67 percent were covered, compared with 51 percent four years earlier. The survey did not explicitly ask whether Hispanics spoke English, but categorized people based on the language they used to answer questions. Spanish speakers accounted for half of the Hispanics surveyed.

Robert Seifert, principal associate at the Center for Health Law and Economics at the University of Massachusetts Medical School, cautioned that the data are two years old and that various organizations have been working in recent years to enroll non-English speakers.

“It’s still a challenge,’’ said Seifert, who was not involved with the study. “I think the state recognizes that it’s a challenge.’’

The study authors said many Spanish speakers need ongoing assistance because they have never had insurance before. One-third of those who answered the survey lacked a primary care doctor, compared with less than 10 percent of non-Hispanic whites.

The consumer group Health Care for All operates an insurance help line that receives more than 35,000 calls annually, half of which are from Spanish and Portuguese speakers. Research director Brian Rosman, an author of the study, said people need more personalized, one-on-one assistance that is based in their community.

Figueroa started telling her clients last week that her job may be ending. They are angry, she said.

And she is worried, especially for those in the middle of the enrollment process.

“They’re all going to be left behind,’’ she said.

Chelsea Conaboy can be reached at



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