Latinos lag in health insurance enrollment

Children are particularly vulnerable, although citizens

Not long ago, Graciela Camarena, a community health worker in the Rio Grande Valley, had a perplexing case. Over a two-year period, the U.S.-born daughter of a single, working mother kept getting turned down for Medicaid coverage even though her brother was enrolled in the public health plan.

The situation was fraught because the 12-year-old girl was ailing. She had developed breathing problems and was always fatigued, to the point that she couldn’t participate in gym class.

With the help of Camarena, who works for the Children’s Defense Fund-Texas, a child advocacy nonprofit, the mother again applied to the state’s Medicaid agency. Despite Camarena’s certainty that the girl met all the qualifications, the application was again denied.

“It made no sense that one child was in and one was out,” Camarena said in an interview.

This time Camarena pressed the agency for a review. After six weeks or so, the mystery was solved. The agency had miscoded the application, identifying the girl not as a child but an adult, which in Texas meant much more stringent income requirements.

The girl, a Latina, was finally enrolled. Two weeks later, Camarena said, the child underwent surgery to repair a faulty heart valve that could have cost her life.

“Having health insurance literally saved her life,” Camarena said.

But more than 1.8 million Latino children in the United States do not have health insurance, and the situation has grown more dire in recent years, advocates say. The share of all children without health insurance has risen since 2016, but the increase has been most pronounced for Latino children.

According to a recent analysis by the Center for Children and Families at Georgetown University, in 2016 the percentage of non-Latino children without insurance stood at 3.7%, compared with 7.7% for Latino children.

By 2019, the numbers had climbed to 4.4% for non-Latino children and to 9.3% for Latino kids.

The report blames the rising rates of uninsured Latino children on antiimmigrant federal policies and rhetoric during the Trump administration, including the targeting of immigrants who use public safety net programs and cutting of funds for outreach efforts to enroll people in health insurance. But it also highlights state actions, including decisions not to expand Medicaid eligibility under the Affordable Care Act and bureaucratic procedures that can make it difficult to maintain enrollment in Medicaid.

The report says some of the federal and state actions have reduced enrollment for all children, but Latino children have been particularly affected.

“Something that jumped out to me was how incredibly important state policy decisions are,” said Kelly Whitener, a public health coverage expert at Georgetown and co-author of the report, which analyzed U.S. Census Bureau data.

The citizenship status of the children has not been an obvious factor in the rising rates of Latino children without health insurance. Most Latino children living in the United States — 95%, according to the Georgetown analysis of census data — are U.S. citizens. The report suggests, however, that the immigration status of parents and their proficiency in English both affect whether their children will be enrolled in health insurance.

In the case of the Texas child, for example, her mother was living in the United States without legal documentation and so did not qualify for Medicaid for herself.

The timing of the increased numbers of Latino kids without insurance, coming as the coronavirus pandemic hit the United States, was alarming, said Matthew Snider, a senior health policy analyst with UnidosUS, formerly known as the National Council of La Raza, the nation’s largest Latino civil rights and advocacy organization.

“It is very disturbing, not least of which because these trends were occurring as Latino kids were entering this tremendous health crisis, which put them in an even more vulnerable position,” he said.

Some experts, including Edmund Haislmaier, a senior health policy analyst at the conservative Heritage Foundation, were unmoved by the Georgetown report and its findings.

“It’s like looking at reservoirs in California,” he said. “Do you describe how full they are or how empty they are? Instead of saying the uninsurance rate among Latino kids has gone from 7.7% to 9.3%, you could say the insurance rate has gone from 92.3% to 90.7%. It’s still above 90%.”

And many people choose not to enroll in insurance, he said, and are able to take advantage of opportunities for free health care.

In 2017, the Trump administration slashed funding to help people enroll in ACA health insurance marketplaces. That program paid for public service announcements as well as community guides, called navigators, who could walk residents through the often confusing signup process for both ACA plans and Medicaid. The Biden administration has restored that funding.

In 2019, the Trump administration expanded the federal “public charge” rule, which sought to deny legal status to immigrants who used safety net programs such as Medicaid. Although the final rule exempted programs used by children, immigrant advocates said it deterred many Latinos.

“There was widespread fear in our communities, and you could see people going back into the shadows,” Camarena said. “We saw many families not applying or not renewing or literally pulling out of these services even though they were entitled to them.”