Ledy Ordoñez isn't surprised that Latinos in California have been slow to sign up for coverage under federal health law, even though they've been a top priority for enrollments in the state.
"They're scared," the 43-year-old Fremont woman said as she worked at her imported clothing and jewelry stand at a farmers' market in Oakland's Fruitvale neighborhood. "They're afraid if they put in an application for their children ... they'll get deported."
Disappointing enrollment figures for Latinos are causing Covered California officials to rethink they way they reach out to this population, which is considered key to the success of the rollout of the Affordable Care Act in the state.
Latinos account for more than half the state's nearly 7 million uninsured residents, but they accounted for only about 13 percent of the enrollees in Covered California during the first two months of operation. They are important to the success of the Affordable Care Act in the state because they tend to be younger and healthier than the average population, and their participation will help create a balanced and affordable insurance pool.
"The numbers are not ideal," said Santiago Lucero, spokesman for Covered California. "We knew from the beginning this was going to be a slow process for people in general, but especially Latinos."
Monday was the deadline to sign up for coverage for those who want it by Jan. 1, but the enrollment period continues through March 31.
Deportation fears aside, there are several reasons for the lagging enrollments among Latinos, Covered California officials say. Among them is confusion. Many Latinos new to the country may not understand what health insurance does and why it's needed, let alone grasp how to navigate the various policy options and the terminology used in the signup process.
Added to that is Covered California's difficulty in finding an adequate number of enrollment counselors and certified insurance agents to help Spanish-speaking residents understand what they have to do, an especially difficult problem for a community that for cultural reasons generally prefers face-to-face contact over online navigation.
"The lack of knowledge in computers makes it difficult for the Latino population," said Jorge Najera, a bilingual insurance agent in San Francisco's Mission District.
The cost to buy coverage is another hindrance for people who have never had health coverage, Najera said, although a large percentage of California's Latinos - about 46 percent - are eligible for federal financial assistance to help cover the cost of premiums purchased in the exchange.
The immigration fears loom large. People who are not living in this country legally are prohibited from buying coverage though the state or federal health exchanges created by the health law, but they fear they will get noticed by immigration officials if other members of their family sign up for coverage.
Immigration not issue
U.S. Immigration and Customs Enforcement has sent out notices to assure people that personal information submitted by members of a household as they apply for health insurance under the Affordable Care Act would not be used for immigration enforcement.
Daniel Zingale, senior vice president with the California Endowment, said that message may not be enough. "I think something from the president himself would be helpful," he said.
The California Endowment, which advocates and invests in health equity issues, has committed to spending $25 million on outreach to community groups and $20 million more on Spanish-language media to get the word out.
More direct outreach
The organization's efforts have involved helping to get people trained by Covered California so they can talk to Latinos at soccer games, farmers' markets, churches, neighborhood events and even at consulate offices.
But, Zingale said, "the first order of business is fixing the systems that have failed to open the doors to Latino applicants," he said.
Peter Lee, Covered California's executive director, said the agency is working to get more in-person help to Latinos as well as make it easier for people to find that help. He said the "find help near me" feature on the website is being made more prominent in Spanish, and additional changes are on the way.
At the Oakland farmers' market, Ordoñez admitted she's been slow to sign up for coverage, even though she hasn't had insurance for more than five years. But she said she has an excuse; she just returned from visiting friends and family in her native Ecuador this past month.
Carmen Joachin, who operates a kettle-corn stand and is bilingual, said she's fortunate to have health insurance through her husband, but she intends to encourage her brothers to get coverage. She said her brothers pay cash whenever they go to a doctor, but she's worried about the costs if they ever need to be hospitalized.
"It is on their minds to buy this insurance," said Joachin, who is originally from El Salvador. "My brothers, it's difficult for them to speak English. It's a big barrier for them ... but I'm happy there's this opportunity."
Victoria Colliver is a San Francisco Chronicle staff writer. E-mail: vcolliver@sfchronicle.com
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