Dr. Dharma Cortés on Health Care and Latinos

On March 23, 2010, President Barack Obama signed his comprehensive health care reform bill into legislation, marking a major milestone for our nation as well as our health care system. While this is an important step in health care access, with more than 30 percent of uninsured Americans being Hispanic, many questions still arise.

“No One Asked Me” – Latinos’ Experiences with Massachusetts Health Care Reform, a study commissioned by the Robert Wood Johnson Foundation and conducted by Dr. Dharma E. Cortés, Senior Research Associate of the Gastón Institute for Latino Public Policy and Community Development at the University of Massachusetts Boston, took an in depth view at Latinos’ experiences with the Massachusetts Health Care Reform law.

In 2006, Massachusetts became the first state to implement a statewide regulation for accessibility to health care. Many similarities exist between this state’s bill and the national bill and the experiences faced by Latinos locally can begin an early dialogue to ensure the gap in health care access is bridged.

Dr. Dharma E. Cortés (Ph. D)

In this exclusive interview for BrazilNYC, Doctor Cortés talks about the similarities between the Massachusetts Health Care reform in 2006 and the recently-signed bill, focusing on the impact that both bills have on the Latino populations across the country.

Besides the written Q&A below, we also did a 30-minute phone interview with Dr. Cortés, which is featured on the podcast player below. Just click on the play button.

Rodrigo Brandão: Can you outline some of the most relevant ways in which the 2006 Health Reform in Massachusetts was similar to the current Federal bill signed by President Barack Obama on March 23, 2010?

Dr. Dharma E. Cortés: I am going to answer this question focusing only on the areas covered by my study. In this regard, one of the similarities is the individual mandate that requires U.S. citizens and legal residents to have health insurance in both laws. Another similarity is the creation of a subsidized health insurance program in Massachusetts, the Commonwealth Care Health Insurance Program, for residents who earn less than 300% federal poverty level (FPL) and are ineligible for MassHealth (Medicaid).

The Federal bill will create similar, although slightly different state-based American Health Benefit Exchanges through which individuals can purchase coverage with premium and cost-sharing credits available to individuals/families with income between 133-400% of the FPL.

Another similarity is the creation of an independent quasi-public authority— the Commonwealth Health Insurance Connector (in Massachusetts) — created to serve as a clearinghouse to connect individuals and small businesses with health insurance products. The Federal bill stipulates the creation of an internet website to help residents identify health coverage options (effective July 1, 2010) and the development of a standard format for presenting information on coverage options (effective 60 days following the bill’s enactment).

RB: On your study, now available online, you address the issue of bureaucratic proficiency, or more specifically, the difficulty of  navigating through the health care system “due to its myriad of requirements and regulations, and technical language.” You also mention the lack of proper literature available to non-English speaking citizens.

Is this being currently addressed in Massachusetts and at the Federal level, going forward? Are there any attempts to both simplify the health care process and convey its procedures in a clearer and simpler way?

DC: Although my study did not assess the adequacy of the information available to consumers, it found that participants experienced difficulties deciphering technical language related to eligibility requirements and insurance cost (e.g., deductible, premiums, etc.), among others. In Massachusetts attempts were made to make the information accessible to its residents. However, residents such as the ones I interviewed still faced communication challenges. The internet website (see response to question #1) that will be created as part of the new Federal law will develop a standard format for presenting information on coverage options, and I hope that the information is presented in clear, plain language in order to facilitate comprehension.

RB: Another interesting section of your study has to do with the importance of community-based institutions, and how essential they are in relaying technical and procedural requirements to people on the ground, on their own terms and language. You also discovered that “Spanish speakers needed more help than those who spoke English,” and that in some cases “without the help from the community-based organization, it would have been impossible for [some] to obtain health insurance.”

Why do you think Spanish speaking Latinos needed more help than English speakers? Is that as simple as a language barrier problem?

DEC: Chances are that Spanish-speaking Latinos, living in a mostly English-speaking world, have limited exposure to information readily available in Spanish. The limited availability of information in their native language, combined with limited experience navigating the health care and health insurance systems (especially for those who had never had coverage) further aggravates the language barrier problem.

RB: Can you give me some examples of local and Federal institutions that already act as an intermediary between citizens and insurance providers? Can one easily find these institutions, no matter the state they live in the US? And lastly, are there any attempts to regulate what these community organizations can (and should) do?

The individuals that participated in my study sought help from multiservice community based organizations that they were familiar with. The Federal law will make grant funding available for states to establish or support consumer assistance offices and health insurance ombudsman programs. As noted earlier (see response to question #1), the Federal law stipulates the creation of an website to help residents identify health coverage options (effective July 1, 2010) and the development of a standard format for presenting information on coverage options (effective 60 days following the bill’s enactment).

RB: One of the conclusions of your study was that “Latinos’ connection with community-based organizations was instrumental for their successful health insurance enrollment.” Is this discovery being taken into account at the Federal level? What can be done in terms of facilitating the creation of new community-based institutions, in places where they don’t yet exist? And lastly, could the Federal and State officials coordinate their efforts to train community leaders to step in and take over some of these responsibilities?

DC: As far as I now, the federal government will provide grant funding opportunities to establish or support consumer assistance offices and health insurance ombudsman programs.