Health Care Repeal Could Threaten Historic Gains For Latinos

By  Will Stone
Published: Thursday, July 27, 2017 - 10:53am
Updated: Thursday, July 27, 2017 - 4:29pm

(Photo by Will Stone - KJZZ)
Angela Florez, chief development officer at Valle del Sol, (left) and patient Virginia Valenzuela (right), stand in the lobby at one of the community health center's locations in Phoenix. The Latino community has seen historic gains under the ACA.

Walk into one of Valle del Sol’s clinics and English may not be the first language you hear.

“All of our medical assistants are bilingual,” said Angela Florez, chief development officer for the community health center. Behind her, bright murals, one depicting children of different ethnicities holding hands, line the walls of the lobby.

“Even the design of our facilities, if you look at our patient rooms, they are larger than most, with more seats than most, because we understand intuitively that with a Latino family, they are not just going to bring one other person,” she said.

Valle del Sol was founded in the 1970s, in particular to serve central Arizona’s Latino community. This clinic in central Phoenix has expanded in recent years as their patient load has doubled under the Affordable Care Act (ACA).

Despite being well-represented in the workforce, Latinos have lagged behind the rest of the country when it comes to health insurance. Before the Affordable Care Act, one out of three adult Latinos lacked coverage. Those numbers are finally improving. In Arizona, their uninsured rate has fallen from 30 percent to 17 percent as of 2015, but some worry a repeal of the health care law could undo that progress.

Virginia Valenzuela is one of those now covered.

After three decades of steady employment, a shoulder injury and a botched surgery forced her to quit her job as a legal assistant. She’s now on Medicaid, known as the Arizona Health Care Cost Containment System (AHCCCS).

“I didn’t want to do it, but I’ve gotten to the point where I basically need it,” Valenzuela said.

She has been coming to Valle del Sol for three years ever since Arizona expanded Medicaid using extra funding tied to the ACA. That allowed low-income, single adults like Valenzuela to enroll. But so far all the Republican replacements for the ACA would phase out the expansion, ending coverage for more than 400,000 people who have joined the rolls.

“I still have this injury. What if this insurance is pulled out from under me and I do have to go back to work? I may not even be able to afford insurance,” Valenzuela said.

About half of those on Medicaid in Arizona — close to a million people — are Latino. Senate Republicans' legislation, the Better Care Reconciliation Act, proposed deep cuts in order to slow the growth of the program. Governor Doug Ducey and Senator John McCain have expressed concerns about the impact that would have on the state's program. On Tuesday, shortly after casting his vote in favor of opening debate, McCain said he would not support any bill that doesn't address those concerns.

Arizona health officials estimated the BCRA could eventually cost Arizona $7 billion. Such a cost shift would likely force the state to reduce benefits and who’s eligible.

“We have seen specific gains in the amount of Hispanic patients that have been able to come into our offices and be covered,” Dr. Pedro Rodriguez-Guggiari said.

Rodriguez-Guggiari practices family medicine in Phoenix and is on the board of the Arizona Latino Medical Association. He said affordability is the main reason his patients have forgone health care. But cultural differences are a factor, too.

“They are afraid they are going to bother someone and be a burden. You’d be surprised how many come and say, 'I am sorry I have to use this service,' ” he said.

That misconception can be overcome, but it begins with them having access to affordable insurance, he said.

“Once there’s coverage, they can come and we can talk,” he said.

Despite historic gains under the ACA, Latinos still make up a disproportionate number of those without insurance.

Naomi Lopez Bauman with the Goldwater Institute blames the ACA for focusing too much on coverage and not access.

“Hispanics tend to be younger and heathier than the rest of the population. They don’t see a value in paying for a product they probably won’t use, especially when there isn’t necessarily a very direct connection to the provider,” Lopez Bauman said.

Many have seasonal jobs without insurance, while others prefer to go to a nearby pharmacist or retail clinic instead of a traditional provider, she said.

“It can’t be one size fits all. There are lots of complex reasons why people are uninsured, and I don’t think the Affordable Care Act is a good fit for these populations,” she said.

Bauman doesn’t support the Republican bills proposed in the House or Senate so far, but she does favor capping Medicaid spending in exchange for more state flexibility. With less federal oversight, states can deliver health care in new ways, she said.

But Sara Collins with the Commonwealth Fund said it’s not necessarily that Latinos aren’t interested in getting covered.  

“Latinos started out higher in terms of uninsured rates than both whites and blacks. They just have a lot further to go,” she said.

Collins also points out that the ACA excludes undocumented immigrants. Still, she believes more Latinos will sign up if they are aware of what’s available.

“You can’t overstate the importance of outreach and enrollment activity on the part of federal and state governments,” she said.

In fact, a 2016 analysis by the Commonwealth Fund found most of those who are still uninsured think they can’t afford insurance, even though the majority should be eligible for Medicaid or marketplace subsidies.

More than 200,000 people are enrolled in Arizona's individual marketplace, which has seen an exodus of insurers in recent years and a spike in premiums. About half of those who identified their race when they bought plans are Latino.

Angela Florez of Valle del Sol said they’re making inroads with some of these harder-to-reach communities. If the ACA is repealed and Medicaid expansion ends, her organization could see as much as a 35 percent cut.

“That, for Valle, would be devastating,” she said.

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