Kaiser Health News Service

Andrea Velandia, 29, is just the sort of person health law regulators are seeking to draw into the new online insurance marketplaces– young, healthy, uninsured and Latino.

“We’re very healthy. We don’t have many issues,” she says of her family. Right now, she and her husband mostly avoid the health system because “it’s very expensive to go to the doctor to get a regular checkup. And you only have an option to go to the emergency room, which is even more expensive.”

On Oct. 1, Velandia, who is from Colombia, will be able to sign up her family of four for a subsidized health insurance policy in the new Maryland Health Benefit Exchange, the state’s online marketplace for insurance policies created under by the Affordable Care Act.

Just as Latinos were crucial to President Barack Obama’s re-election success in 2012, they are now key to the success of his health law. And the administration is doing everything it can to make sure that Latinos, like the Velandias, enroll.

The administration announced this week that Health and Human Services Secretary Kathleen Sebelius will be making the rounds on Spanish-language media outlets to discuss the health law and unveiled the newly revamped CuidadoDeSalud.gov, the Spanish version of HealthCare.gov.

Latinos make up 17 percent of the total U.S. population, but 32 percent of the nation’s uninsured. They’re also more likely to be young – nearly half of Hispanics are under the age of 26. That’s important for the insurance pools because young and healthy people need fewer medical services and insurance companies can use their premiums to help subsidize coverage for older or sicker patients.

On a recent morning, Velandia visited the legal clinic at the nonprofit community organization CASA de Maryland in Langley Park to get help filling out the last bit of paperwork to become a U.S. citizen (her husband is already a citizen). Sitting patiently with her toddler and newborn, she was approached by one of the center’s promotoras – lay health promoters who help spread public health information to the Latino community – and offered some basic information about breast cancer, healthy eating and diabetes.

In just a few months, CASA de Maryland’s 20 promotoras will be expanding their outreach to include information on signing up for a new health insurance policy as well. The organization recently received a special grant from the state to help Latinos and other immigrants sign up for the exchange. It is one of 10 organizations in Montgomery and Prince George’s counties that will use $7.8 million in “navigator” funding to educate and enroll uninsured residents.

George Escobar, health and human services director at CASA de Maryland, says he plans to use the grant to train his promotoras and hire a dozen new employees to work fulltime on enrollment. One navigator will be stationed in each of the organization’s seven centers. The rest will be mobile, traveling throughout the community and seeking to enroll people at local businesses, supermarkets, churches, schools, apartment complexes and community events.

Jennifer Ng’andu, who is the director of the health and civil rights policy project at the National Council of La Raza, says Latino organizations have their work cut out for them. The congressional health care debates of 2009 and 2010 created a sense of distrust in the community, she said, because there was a focus on how to keep undocumented immigrants from using any of the health law benefits. People who are legal residents are eligible to use the insurance marketplaces and receive tax credits to help pay for premiums, but many face a five-year wait before they are eligible for Medicaid.

“The take away often was that there isn’t really anything in the Affordable Care Act for the Latino community,” says Ng’andu. “Many people forgot to talk about the fact that there are a broad set of Latinos who are lawfully present and who will gain the benefits of the Affordable Care Act.”

She adds that the current congressional debate about overhauling immigration law is adding more fear and confusion, especially in families where some people are citizens and others are not. “Even if everyone in a household is legal, they still have different eligibility from each other. And so teasing all of that out can be difficult and the process will be complex to enroll individuals in mixed-status families,” she explains.

The nation’s 11 million undocumented immigrants will not be eligible for the new insurance options. The law explicitly bars them from purchasing insurance on the exchanges, even with their own money. If the immigration bill moving through the Senate becomes law, those here illegally who seek to become citizens won’t be eligible for coverage for at least 13 years after bill passage.

“This is a challenge that’s not going to go away with health reform,” says CASA de Maryland’s Escobar. “We’re excited about health reform, we think it’s a wonderful objective, but at the same time, there are a number of people that will be left out regardless of what happens.”