By Barbara Feder Ostrov, KHN News

Covered California still faces major challenges in enrolling African-Americans and Latinos as the state’s health insurance exchange launches its third open enrollment period.

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“We know we’ve come up short in who’s enrolled today,” Covered California Executive Director Peter Lee said at a recent media briefing on the exchange’s marketing and outreach plans. “Of those who are still uninsured, we want to make sure we reach them.”

About 2.4 percent of the exchange’s approximately 1.3 million enrollees are African-American, only about half of the Blacks considered eligible for subsidies because of their income. Another 30 percent are Latino; 37 percent are considered eligible for subsidies, according to Covered California data.

In contrast, enrollment of whites and Asians has exceeded eligibility projections, meaning that Covered California was better able to reach those groups. The state’s enrollment data is not exact, because more than a quarter of enrollees decline to state their race.

While many more California Latinos and African-Americans have become insured since the passage of the Affordable Care Act, including through the state’s Medi-Cal expansion and employer-based insurance, Covered California’s experience echoes that of other states trying to ensure that their minority populations get the health coverage they need, said Larry Levitt, senior vice president at the Kaiser Family Foundation.

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About 55 percent of the nation’s remaining 32.3 million uninsured under age 65 are people of color, including 34 percent who identify as Hispanic/Latino and 14 percent who identify as black, according to Kaiser Family Foundation data. (KHN is an editorially independent program of the foundation.)

In California, about 2.2 million Californians remain uninsured but are eligible for Medi-Cal or Covered California insurance plans, Lee said. They are more likely to be Latino and African-American, and younger and slightly more affluent than current enrollees, who may have qualified for subsidies or Medi-Cal, the state’s version of Medicaid.

Covered California has earmarked about $50 million for marketing and another $13 million for navigators, trained counselors who help people learn about and sign up for coverage.

The exchange was expected to unveil its new advertising campaign Friday, including ads specifically targeted to Latinos and African-Americans. Covered California’s open enrollment runs from Nov. 1 to Jan. 31, 2016.

Explanations for the disproportionately low enrollments of eligible African-Americans and Latinos vary. “We’ve got people who don’t trust the government,” said Dan Daniels, coastal area director of the NAACP California State Conference, who oversaw Affordable Care Act outreach in his region.

Daniels also cited attitudes among “young invincibles,” who are healthy enough to think they don’t need coverage and are willing to pay the mandatory penalty for not having health insurance. That penalty will rise in 2016 to $695 per person or 2.5 percent of income, whichever is higher.

Among some Latinos who are legal residents, there is fear that applying for health insurance through Covered California will jeopardize the immigration status of other family members, Levitt said.

And affordability remains a looming concern for higher-income people of color who may not be eligible for subsidies or Medi-Cal.

For example, Kemisha Roston, a 38-year-old contract lawyer from Riverside, said she makes too much money to qualify for those programs, but not enough to afford Covered California unsubsidized premiums – which top $300 per month — while she pays off student debt.

“I’m living check to check, because the market for attorneys is very saturated,” Roston said. “My health is pretty good right now, so I don’t need to go to the doctor. When I do, I go to free clinics or Planned Parenthood. I’m dismayed, because if something does happen and I don’t have health insurance, I could be wiped out.”

Kaiser Health News (khn.org) is a nonprofit national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

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