A Last Push for Obamacare Sign-ups — and Worries About Who Got Hurt

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PLAINFIELD, N.J. — Denise English was one of just two employees working six days a week to handle the crowd of people signing up for health insurance under the Affordable Care Act at a neighborhood health clinic here, as the Friday deadline for open enrollment loomed.

Most of the people who sat waiting wanted to speak to her co-worker, who speaks Spanish. But Ms. English — she speaks only “un poquito” — was doing her best, her phone open to Google Translate, as she tried to help clients like Ana Gonzalez and Celso Morales, who moved here from Puerto Rico in April, sign up for a subsidized health plan.

“Obamacare,” Mr. Morales said, using one of the few English words he knows.

With the law’s enrollment period shortened and outreach resources cut under the Trump administration this year, people like Ms. English have been working urgently to preserve one of the major achievements of the health law — the remarkable decline it brought in the proportion of blacks and Hispanics without health insurance.

“Without question,” said Dr. David Satcher, a former surgeon general of the United States, “the Affordable Care Act represents the biggest gain in coverage we’ve seen for African Americans since the creation of Medicare and Medicaid” more than a half-century ago.

Steven T. Lopez, a health-policy specialist at UnidosUS, a Hispanic rights group formerly known as the National Council of La Raza, echoed that assessment. “The law has resulted in historic coverage gains for our community,” he said.

Nationwide, the Trump administration slashed spending to advertise open enrollment and sharply reduced grants to insurance counselors known as navigators who help people sign up for coverage. Here in New Jersey, the navigator budget was cut 62 percent, to about $720,000, from $1.9 million last year. The administration also cut in half the enrollment period for the federal insurance marketplace, used by New Jersey and 38 other states, to 45 days.

Just as the gains have helped blacks and Hispanics, the cutbacks are likely to hurt most in communities like this one, a small city in central New Jersey where blacks and Hispanics account for a majority of residents.

“We know how much the one-on-one assistance meant to getting people enrolled, particularly in communities of color, and I think in communities where English is not the primary language spoken,” said Maura Collinsgru, the health care program director for New Jersey Citizen Action, which joined other nonprofit groups in setting up a website, CoverNJ, to encourage enrollment despite the hurdles this year. “That’s really where there was a great deal of effort put over the last several years — we have lost that almost completely.”

Hispanics and African-Americans are still much more likely than whites to be uninsured. But the health law has markedly reduced racial and ethnic disparities in coverage.

Among adults age 18 to 64, the uninsured rate for Hispanics is now about 17.9 percentage points higher than for whites, down from a difference of 26 percentage points in 2013, according to the National Center for Health Statistics. And the uninsured rate for blacks is 4.6 percentage points higher than for whites, compared with a gap of 10.4 points in 2013.

Before the Affordable Care Act, large numbers of Hispanics were uninsured, in part because many had low-wage jobs that did not offer insurance. Even with the health care law, many Hispanics are ineligible for Medicaid and insurance subsidies because of their immigration status.

Still, the overall rate of Hispanics without health insurance is down to 16 percent, from 24.4 percent in 2013. The rate of uninsured African-Americans has dropped only slightly less dramatically, to 10.5 percent from 15.9 percent in 2013, according to the Census Bureau.

Dr. Satcher said the gains in coverage are also threatened by cuts in federal subsidies paid to insurance companies on behalf of low-income people and by provisions of the Republican tax bill that would, in effect, eliminate the requirement for people to have coverage.

Demand for health insurance through the Affordable Care Act marketplaces has remained strong during this enrollment period — sign-ups were running ahead of the same period last year, even in states like New Jersey, where Republican governors have been lukewarm about promoting the health law. But because the enrollment period in the HealthCare.gov marketplace was half as long, the overall number of people who sign up is expected to be lower than in the last couple of years. (A preliminary tally is likely to become available next week.)

The effects of the federal cuts on minority residents are evident in the work of the Center for Family Services, which serves seven counties over 3,000 square miles in southern New Jersey.

The nonprofit had its federal funding cut by 64 percent, reducing the number of navigators from 21 who spoke six languages between them to 6 who speak English and Spanish. As a result, it stopped doing enrollment at several locations in Camden, a poor and majority black and Hispanic city.

“We’re not reaching out to those communities because there’s less of us,” said Pamela Gray, a navigator with the group, one of five that received the federal funding in New Jersey. “We’re still getting out there and doing events,” she said, “but the less people, the less people you’re able to serve.”

Over the past six weeks, the Black AIDS Institute, in partnership with a dozen other health care and civil rights groups, has held enrollment events in 18 cities including Atlanta; Richmond, Va.; Chicago; and Los Angeles. The goal, said Lestian McNeal, the program coordinator for the institute, was to “fill the void in government support created by the Trump administration.”

The groups sought out uninsured African-Americans, especially those at risk of developing AIDS. In some cases, Mr. McNeal said, “enrollment assisters” helped people find plans that were essentially free because financial assistance in the form of tax credits covered the entire premium.

Across the country, many public libraries held open enrollment events, hoping to fill in the gap where there were fewer navigators.

The Neighborhood Health center here has tried to make up for the loss of federal funds by going into local churches to remind people that open enrollment was coming to an end and setting up a makeshift enrollment center near a bustling pediatric clinic.

But because of budget cuts, the center laid off three people who had done enrollment counseling — including one who spoke Spanish and one fluent in Creole.

Without many television ads, Ms. English said, people seem to be getting their information about the Affordable Care Act from the news, where Republicans are repeatedly threatening to repeal the law and warning that insurance markets are collapsing.

“The cuts to advertising, and the media, have put it in people’s head that it’s going to be too high and they can’t afford it,” Ms. English said. “Then when we do tell them what it’s going to cost, they would just be shocked. ‘Oh, the media said it was going to be expensive.’ We say, No, no, you just need to do it.”

Ms. Gonzalez and Mr. Morales, who moved to New Jersey from Puerto Rico, came to sign up for coverage on the advice of one of his co-workers after Mr. Morales was told he has diabetes. The couple — she is 54 and he is 58 — qualified for Medicaid in Puerto Rico, but in New Jersey, their income is too high. They earn about $35,000 a year between her job at Target and his work laying stones for a construction company. With the Affordable Care Act tax credit, they will pay just under $200 a month to cover the two of them, a sum that seemed to please Ms. Gonzalez.

Lisbeth Lopez, 23, whose parents came to the United States from Colombia, had seen ads for open enrollment on a Spanish language television station. She had coverage as a college student, but she graduated in May and has been unable to find work as a paralegal.

“I’m hoping to get a job soon, but I have to start paying for health insurance,” she said. While some of her friends think they can get by without it, she said, “I just imagine what if something happens to me, where do I turn?”

She had come with her brother, who was signing up, and her mother, who signed up two weeks ago. “We had to look for seats,” her brother, Luis Valentin, said. And after two hours of waiting, there were still eight people waiting to be helped before them.