Some minority populations underserved by ACA

Some minority populations underserved by ACA

Upstate Business Journal
November 4, 2015

by Ashley Boncimino

While more South Carolinians have health insurance this year than last, the Palmetto State still has the 11th highest uninsured rate in the country, and some communities are gaining ground faster than others.

Take the state’s Hispanic population, for example. The uninsured rate for that ethnic group is more than double that of African-Americans in the state, yet the rate improved more dramatically for African-Americans as well as for the population overall. The same goes for the state’s low-income population, or people who make $25,000 per year or less, in which more than a fifth report not having health insurance, according to an Upstate Business Journal analysis of U.S. Census data.

This week marks the start of the third enrollment period for health insurance under the Affordable Care Act. That means health care providers, nonprofits, health navigators, brokers, insurance agencies and others are wrestling with the challenge of reaching the more than 700,000 South Carolinians still without health insurance.

The challenge is as much of a cost-savings plan and business opportunity as it is bettering people’s lives, according to Roz Goodwin, vice president for community engagement with the South Carolina Hospital Association.

“Health insurance is something they understand, they need and want,” she said. “Until now, for a bulk of our population it’s that it’s not affordable.”

Goodwin works with organizations across the state on educating and connecting more people with health insurance, including those who might have subsidies or other resources to help pay for it. They meet regularly and collaborate to plan enrollment events, share best practices and strategize about how to most effectively reach those populations.

Marriage is a huge life event that affects your health insurance status, for example, so they might send someone to a bridal show, she said. The same goes for churches, community centers, libraries, even chambers of commerce, she said.

“It’s about getting them through organizations that they already trust and are connected with,” she said. “We’re not waiting for patients to come into our hospitals to seek coverage. … We’re going into the community.”

Hospitals are required by law to serve patients who show up in the emergency room, regardless of health insurance, which means the uninsured are a huge line item for hospitals, she said. In addition, health coverage often represents preventive care that leads to better treatment that might circumvent more costly procedures and care down the line. While it’s certainly a new undertaking for hospitals, she said, “it’s one we feel a responsibility to take on.”

Here in the Upstate, Greer-based insurance broker Guy Furay said he’s changed his business to take aim at the underserved Hispanic and African-American communities in the region. Two recent hires include a 10-year insurance veteran who has already been successful in reaching the African-American community in Greenville, as well as a trilingual employee to help break down communication and trust barriers with Hispanic communities.

“Someone in the African-American community might not really understand what the law does, how it all works. It’s not rolled out in the easiest way possible,” said Furay, who runs The Insurance Source in the Upstate. “The reason why someone in the Hispanic community – some of which would benefit a lot from the ACA – might not use it is they don’t know or they don’t trust. We’re trying to break down barriers.”

Because the law is so new, researchers have not had much time to look into why certain segments of the population are harder to reach with health coverage resources, said Myriam Torres, director of the Consortium for Latino Immigration Studies and a clinical assistant professor at the University of South Carolina.

“We see right now the behavior, the demographics of the population is changing, meaning probably more than half of the Latino population in South Carolina is either born here or naturalized citizens … which means we have many more people eligible for the Affordable Care Act,” she said, noting that researchers would have to wait for more data. “Latinos are spending out of pocket lots of money for health care, so it is a need to have coverage, and it has been for, I guess, every population in the United States.”

Part of the problem for South Carolinians is the coverage gap, where an estimated 135,000 state residents are too poor for coverage through the Affordable Care Act but too rich for Medicaid. South Carolina – along with many other states – elected not to expand Medicaid, which remains a significant predictor for the state’s uninsured rate.

While South Carolina has remained staunchly against expanding Medicaid, other options are out there, said Goodwin. Last month saw the launch of Palmetto Plus, a proposal for a private-option solution to the coverage gap backed by a coalition of South Carolina nonprofits, statewide associations, business leaders and the SC Small Business Chamber of Commerce. According to the advocacy group, such a proposal would save the state money, help more than 100,000 South Carolinians and create jobs.

Until that happens, nonprofits, providers and brokers will have to keep trying, said Torres.

“They are trying to do outreach to the population,” she said. “Our population is a population that definitely will get it if it is affordable. There are options.”