No one has as much to gain — or to lose — in the political tug of war over health care reform as the nation’s 48 million Latinos.

    Latinos are the country’s most frequently uninsured group. With undocumented immigrants excluded from reform benefits, the legislation is aimed at working-class and middle-class Latinos who are U.S. citizens. Namely, it is aimed at Latinos likely to vote. Latinos would receive an outsize benefit under the new health reform law that House Republicans voted to repeal last week, but analysts say many Latinos don’t realize the benefit is available because it has not been part of the political discussion.

    “The Democrats put together the first meaningful health care reform in two generations, and most Latinos have no idea of what’s in it,” said Gary Segura, senior political analyst for Latino Decisions, a polling service that identifies national Latino political issues.

    During the original debate on the law, excluding undocumented immigrants from coverage was a flash point that obscured the health coverage gains for Latino citizens.

    According to the White House, Latinos will make up roughly 28 percent of the 32 million uninsured Americans projected to gain medical coverage under the law. That’s nearly double their 16 percent share of the U.S. population.

    The disproportionate Latino stake in the future of reform is repeated in key electoral states.

    * In California, Latinos account for 55 percent of estimated beneficiaries compared with their 36 percent share of the overall population, according to estimates by the California Pan-Ethnic Health Network, a health advocacy organization. Latinos are 59 percent of the state’s nonelderly uninsured, according to the Kaiser Family Foundation.

    * In Texas, which gained four congressional seats in the 2010 census reapportionment, Latinos are 25 percent of eligible voters, according to the Pew Hispanic Center. They are 59 percent of the state’s uninsured population, according to Kaiser.

    * In Florida, which gained two seats, Latinos are 15 percent of eligible voters and 32 percent of the uninsured.

    * In Arizona, which gained a seat, Latinos are 18 percent of eligible voters and 53 percent of the uninsured.

    * In Nevada, which also gained a seat, Latinos are 14 percent of eligible voters and 35 percent of the uninsured.

    With many analysts depicting Latinos as the future of the American electorate, there could be a political cost to rebuffing this growing bloc of voters but only if defenders of reform recognize the issue’s untapped potential.

    Rob Stutzman, a Republican strategist who advised California GOP gubernatorial nominee Meg Whitman, said health reform is a “messaging opportunity that the Democrats are leaving on the table.”

    “I don’t think we’ve seen it defined as a Latino issue at all, even by a Democratic Party that would most benefit from cultivating that specific constituency,” said Stutzman, who has cautioned that his party is alienating Latino voters through its opposition to the DREAM Act for immigrant students and its general stance on immigration.

    Meanwhile, “the Latino share of the total vote has gone up every year nationwide over the previous election cycle,” said Segura, who is also co-director of the Stanford Center for American Democracy. “The Latino electorate will effectively double over an 18-year period, even if not a single immigrant crosses the border or naturalizes.”

    Latinos overwhelmingly vote for Democrats: National estimates place about 65 percent of Latinos in that party camp, about 25 percent backing Republicans and 10 percent for independents.

    As they grapple disproportionately with problems such as diabetes and heart disease, Latinos care a lot about health. A Latino Decisions poll in March 2010 — just before the health care vote in Congress — asked Latino voters to name the single most important issue facing the nation.

    Health care reform topped the list, followed by jobs and the economy, and then immigration reform. Eighty-six percent of the 500 Latinos polled indicated support for the health legislation, according to the survey.

    Latinos were a critical voting bloc last November for Democrats such as California Rep. Jim Costa, who survived a Republican wave with their help.

    Costa’s victory speech specifically thanked Latino mayors and businessmen in his rural California district for helping wring out a 3,050-vote win over tea-party-affiliated Republican Andy Vidak.

    Latinos are 63 percent of his district’s population, according to the census. And nearly one-third of Latino residents in the San Joaquin Valley live without health insurance, according to a survey conducted by the UCLA Center for Health Policy Research. But Costa said that his support for the legislation is not what earned the game-changing Latino vote.

    “You earn it by working hard on the issues that everyone cares about, like water, the economy and better schools,” said Costa, who is of Portuguese descent but has aligned himself with Latinos — from farm workers to professionals — during his four congressional terms.

    Health reform could play a role in exciting the Latino electorate beyond staple issues such as immigration, said Matt Barreto, a University of Washington political scientist who co-founded Latino Decisions with Segura.

    “One problem for the Democrats is they haven’t done a good job of defending the health care bill. They just rolled over,” Barreto said. “They need to point out how many people in the Latino community lack insurance … And if something happens to them [without insurance], they could go bankrupt and lose their house.”

    Supporting Barreto’s point, nearly one in three Latinos nationwide lives without medical coverage. That is the highest national rate for any ethnic or racial group, according to the census. Approximately 9 million of the 15.8 million Latinos currently uninsured nationwide would be eligible to receive coverage under the provisions of health reform, according to White House estimates.

    The political power of the reform legislation comes from the fact that it’s aimed not at the poor, who are less likely to vote, but at working Americans who can qualify for coverage under an expanded version of Medicaid and a subsidized exchange to buy insurance. Individuals can make up to $43,320 to qualify for exchange subsidies, and families of four can earn up to $88,200.

    Still, some advocates said the fact that undocumented immigrants are excluded may be undermining reform’s ability to resonate in the Latino community.

    Jennifer Ng’andu, deputy director of the National Council of La Raza’s Health Policy Project, pointed out that in many Latino families, immigration status differs from member to member. A father might be undocumented, while a mother and child are citizens.

    She said cutting off family members from health reform benefits would make a Latino embrace of the legislation less likely.

    Latino beneficiaries of reform “were sliced off into these boxes that just don’t exist,” she said.

    With Republicans advancing the message that health care reform is too big and intrusive to provide effective medical coverage to the uninsured, Latinos such as Tony Roman, 59, of Moorpark, Calif., remain uncertain about reform.

    He is uninsured and relies on the Westminster Free Clinic in Thousand Oaks, Calif., for treatment of diabetes and high blood pressure. The unemployed warehouse worker, who is of Mexican heritage, has been doing odd jobs to get by and falls into the income category that would qualify for the expanded version of Medicaid, known as Medi-Cal in California.

    “I’ve never been on Medi-Cal, so I don’t know what to expect,” he said. “Maybe put me in a long line, that’s the only thing I can think of. I don’t really know what health reform will do for me.”

    Stutzman said with Democrats failing to drive home the point that Latinos benefit from reform, Republicans will continue to gain traction with their small-government position.

    “The GOP should be talking about costs and delivery and argue against the individual mandate, which I don’t think is popular with any group,” he said, referring to the law’s requirement that nearly everyone keep some form of medical coverage, the main point of contention for the GOP.

    Although full repeal of the law is unlikely, with Senate Democrats refusing even to schedule discussion, Republicans said they will do all they can to obstruct implementation of the law by holding up funding.

    But the law could founder in another way as it wends toward full implementation in 2014. A legal challenge against a provision requiring all citizens to have some type of health insurance — whether privately purchased or acquired through the public benefits system — is likely to make its way through the courts over the next two years.

    Most legal experts believe the issue ultimately will end up before the U.S. Supreme Court.

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